Comparison of Transvaginal and Transperineal Ultrasonographic Uterocervical Angle Measurements in Low-Risk Pregnancies at 24–34 Weeks’ Gestation

<b>Background:</b> The uterocervical angle (UCA) is a promising ultrasound parameter for predicting preterm birth. Transvaginal ultrasound (TVUS) is the gold standard for cervical assessment; however, some patients may decline the procedure due to discomfort or embarrassment. Although transperineal ultrasound (TPUS) offers an alternative associated with less discomfort, comparative data on UCA measurements between these two methods are limited. <b>Objective:</b> We aimed to evaluate the consistency and agreement between UCA measurements obtained using TVUS and TPUS in pregnant women between 24 and 34 weeks of gestation. <b>Methods:</b> In this prospective cross-sectional study, UCA and CL measurements of 189 pregnant women between 24 and 34 weeks of gestation were performed using TVUS and TPUS by a single specialist. Of these, 25 women (13.2%) were excluded due to inadequate TPUS image quality. A total of 164 women were included in the statistical analysis. Pearson correlation analysis, intraclass correlation coefficient (ICC), Lin's concordance correlation coefficient (CCC), and Bland-Altman analysis were performed. <b>Results:</b> UCA measurements showed a high positive correlation between TVUS and TPUS (<i>r</i> = 0.833, <i>p</i> < 0.001). The ICC was 0.827 (95% CI: 0.77-0.87), indicating good consistency, and the CCC was 0.81 (95% CI: 0.76-0.86). The Bland-Altman analysis demonstrated a median difference of 3° between UCA measurements obtained via TVUS and TPUS. The non-parametric limits of agreement, represented by the 2.5th and 97.5th percentiles, ranged from -20.9° to 34.8°. <b>Conclusions:</b> TPUS shows insufficient agreement to be used interchangeably with TVUS for UCA measurement. Although the level of consistency is high, inadequate image quality in a subset of cases and the uncertainty regarding the clinical utility of TPUS-derived measurements for predicting preterm birth limit its current clinical applicability.