To study the predictive value of the parameters of elastography of cervix (E-cervix) by transvaginal ultrasound combined with anterior uterocervical angle for the preterm delivery of high-risk pregnant women. Methods: The clinical data of 82 high-risk pregnant women from April 2021 to May 2022 were collected, and these women were divided into group A (14 women with premature delivery) and group B (68 women with full-term delivery) according to the clinical pregnancy outcomes. E-cervix and transvaginal two-dimensional ultrasound were performed on the women in the two groups during 16-18 gestational weeks and 22-24 gestational weeks. The values of cervical elastic parameters, such as elastic contrast index (ECI), internal / external os strain (IOS/EOS), and hardness ratio (HR), and the anterior cervix angle of the women were compared between the two groups. The predictive value of the values of ECI, IOS/EOS, HR, and anterior cervical angle for the preterm delivery of the high-risk pregnant women was analyzed by receiver operating characteristic (ROC) curve. Results: There were no significant differences in the values of ECI, IOS/EOS, HR, and anterior cervical angle of the women during 16-18 gestational weeks between the two groups (P＞0.05). The values of ECI and IOS/EOS of the women in group A during 22-24 gestational weeks were significantly lower than those of the women in group B, while the values of HR and anterior cervical angle of the women in group A were significantly higher (P＜0.05). The area under the curve (AUC) of the values of ECI, IOS/EOS, HR, and anterior cervical angle of the high-risk women for predicting their preterm delivery were 0.731, 0.776, 0.834, and 0.816, respectively, the sensitivity of which were 71.4%, 64.3%, 78.6%, and 78.6%, respectively, and the specificity of which were 88.2%, 85.3%, 82.4%, and 80.9%, respectively. The AUC, the sensitivity, and the specificity of the combined values of ECI, IOS/EOS, HR, and anterior cervical angle of the high-risk women for predicting their preterm delivery were 0.926, 92.9%, and 95.6%, respectively, which were all significantly higher than those of the ECI value, the IOS/EOS value, the HR value, or the anterior cervical angle value alone (P＜0.05). Conclusion: The value of the E-cervix parameters values combined with the anterior cervical angle value of the high-risk pregnant women for predicting their premature delivery is higher.