Abstract: The disclosed subject matter provides systems and methods for predicting a spontaneous preterm birth based on transvaginal ultrasound images of a subject. An example method can include providing a preterm birth prediction model, obtaining one or more transvaginal ultrasound images of the subject, each including cervical features, determining measurements of a plurality of cervical structure features from the one or more ultrasound images, assessing, using the preterm birth prediction model, cervical health of the subject based on the measurements of the plurality of cervical structure features, and calculating the spontaneous preterm birth risk based on the assessed cervical health, using the preterm birth prediction model.