Spontaneous Preterm Birth Phenotyping Based on Cervical Length and Immune-Mediated Factors

Cervical length (CL) screening by ultrasonographic measurement is an established tool widely implemented in the clinical protocols of preterm birth (PTB) prediction and prevention. Growing evidence has shown immune-mediated factors in the etiology of spontaneous PTB (sPTB), with robust biological plausibility supporting deep interrelationships with progressive cervical shortening. We explore a retrospective cohort study that examined the sequential measurement of CL and leucocyte markers in both singleton and twin pregnancies.1 The study’s objective was to identify the clinical presentations associated with sPTB in relation to variations in these parameters.1 Progressive CL shortening was associated with higher rates of sPTB in both singletons (4.1% vs 2.7%) and twins (41.9% vs 18.2%) as compared with cases with stable CL. In addition, in singleton pregnancies, individuals in the early preterm birth subgroup with a shortened or stable CL had elevated total white blood cell count, neutrophil count, and neutrophil-to-lymphocyte ratio, along with a reduced lymphocyte-to-monocyte ratio, in comparison with individuals in the full-term birth subgroup. However, in twins, similar changes were exclusive to those with a shortened cervix. Finally, the study quantified the association between immune-related indicators and risk of sPTB, incorporating CL. In singleton pregnancies, an increase in the white blood cell count and neutrophil count was associated with early sPTB for both stable and shortened CL. Conversely, in twins, there was a significantly higher white blood cell count, neutrophil count, and monocyte count only in the subgroup with shortened CL