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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2026, vol. 32, issue3
Subject Area: Medicine
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DOI: 10.5272/jimab.2026323.7002
Published online: 07 August 2026
Original article
J of IMAB. 2026 Jul-Sep;32(3):7002-7012
TOWARDS OPTIMIZED PRETERM BIRTH PREDICTION: THE COMBINED VALUE OF CERVICAL BIOMETRY AND BIOCHEMICAL BIOMARKERS
Elitsa Gyokova1,2
, Eleonora Hristova-Atanasova3, Kostadin Kostadinov3, Georgi Iskrov3, Antonia Andreeva4,
1) Department of Obstetrics and Gynaecology, Faculty of Medicine, Medical University – Pleven, Bulgaria.
2) University Hospital "Saint Marina" – Pleven, Bulgaria.
3) Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Bulgaria.
4) Faculty of Medicine, Medical University - Pleven, Bulgaria.
ABSTRACT:
Purpose: Preterm birth (PTB) is a major cause of neonatal morbidity and mortality worldwide. This study assessed the predictive value of combining sonographic parameters—cervical length (CL) and anterior utero-cervical angle—with biochemical biomarkers, foetal fibronectin (fFN) and phosphorylated IGFBP-1 (pIGFBP-1), in symptomatic pregnant women.
Material and methods: In a prospective cohort of 48 singleton pregnancies (28–34 weeks' gestation) with threatened preterm labour, CL and anterior utero-cervical angle were measured by transvaginal ultrasound, and fFN and pIGFBP-1 were tested using qualitative immunoassays. LASSO regression identified key predictors, followed by logistic regression to assess diagnostic performance.
Results: Ten participants (21%) delivered preterm. An anterior utero-cervical angle ≥124° achieved 80% sensitivity and 84% specificity (AUC: 0.892), outperforming CL alone (AUC: 0.829). fFN showed high accuracy (AUC: 0.824) and strong negative predictive value (92.3%). Combining sonographic and biochemical markers improved predictive performance (AUC: 0.95).
Conclusions: The anterior utero-cervical angle is a promising sonographic marker for PTB risk. Integrating it with fFN and other established predictors enhances diagnostic accuracy and may optimize management, particularly in resource-limited settings. Further validation in larger cohorts is warranted.
Keywords: Preterm birth, cervical length, uterocervical angle, fetal fibronectin, phosphorylated IGFBP-1, biomarkers, pregnancy outcomes,
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Please cite this article as: Gyokova E, Hristova-Atanasova E, Kostadinov K, Iskrov G, Andreeva A. Towards Optimized Preterm Birth Prediction: The Combined Value of Cervical Biometry and Biochemical Biomarkers. J of IMAB. 2026 Jul-Sep;32(3):7002-7012. [Crossref - 10.5272/jimab.2026323.70022]
Correspondence to: Elitsa Gyokova, Department of Obstetrics and Gynaecology, Faculty of Medicine, Medical University – Pleven; 1, Kliment Ohridski Str., 5800, Pleven, Bulgaria. E-mail: elitca.gaokova@mu-pleven.bg
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Received: 14 December 2025
Published online: 07 August 2026