Strain at the internal cervical os assessed with quasi-static elastography is associated with the risk of spontaneous preterm delivery at ≤34 weeks of gestation

Hernández‐Andrade, Edgar; Garcia, Manon; Ahn, Hyunyoung; Korzeniewski, Steven J.; Saker, H.; Yeo, Lami; Chaiworapongsa, Tinnakorn; Hassan, Sonia S.; Romero, Roberto

doi:10.1515/jpm-2014-0382

Cited by 41 publications

(35 citation statements)

References 89 publications

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“…The presence of soft tissue in the area of the internal os turned out to be associated with increased risk of preterm delivery. However, no significant associations were found between the risk of preterm labor and elastographic characteristics of the whole cervix and external os, which is consistent with the findings reported by Swiatkowska-Freund et al and Wozniak et al33–36…”

Section: Preterm Deliverysupporting

confidence: 91%

Cervical elastography during pregnancy: clinical perspectives

Swiatkowska‐Freund¹,

Preis²

2017

IJWH

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Uterine cervix is a part of the uterus responsible for maintaining pregnancy till term. As long as the cervix remains long and firm and its internal orifice (os) is closed, it can withstand enlargement of the uterine contents and resultant growing pressure. Mechanical properties of the cervix change during pregnancy; the cervix ripens prior to delivery, then effaces and dilates with contractions of the uterus. Ripening of the cervix can be assessed using the Bishop score and ultrasonographically determined length of the cervical canal and internal os. Consistency is one of the cervical properties that change during the course of the maturation process. Until recently, cervical consistency has been assessed only manually, but in 2007, the first report on elastographic imaging of the cervix during pregnancy has been published. Elastography presents the ability of a tissue to deform under pressure. The softer the tissue, the easier it changes its shape. Different methods of elastography are used – static, when tissue displacement in response to manual compression or physiological movements of vessels is measured, or dynamic, when the speed of shear wave propagation is determined. Irrespective of the method, elastography provides information on the internal os stiffness; this parameter, impossible for manual assessment, was shown to correlate with pregnancy outcome and is a strong predictor of preterm delivery or successful labor induction. Although elastography seems to be a highly promising diagnostic option, still no consensus has been reached regarding an optimal method for uterine cervix assessment, and virtually all previous studies of various elastographic methods produced highly satisfactory results. Future studies need to identify the most promising and objective elastographic method which may serve as a novel tool for pregnancy management, preventing adverse events, such as preterm delivery and unsuccessful labor induction.

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Section: Preterm Deliverysupporting

confidence: 91%

Cervical elastography during pregnancy: clinical perspectives

Swiatkowska‐Freund¹,

Preis²

2017

IJWH

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“…Furthermore, Wozniak et al . and Hernandez‐Andrade et al . found that stiffness of the internal os which seemed to be denser than surrounding tissues provided relatively high sensitivity, specificity, negative and positive predictive values in prediction of preterm labor, thus supporting a popular hypothesis that this anatomical region is crucial for maintaining pregnancy and may play a main role in the mechanism of cervical ripening and labor onset.…”

Section: Discussionmentioning

confidence: 85%

Cervical shear wave elastography as a predictor of preterm delivery during 18–24 weeks of pregnancy

Suthasmalee

Moungmaithong

2019

J of Obstet and Gynaecol

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Aim: The aim of this study was to compare shear wave cervical elasticity between term and preterm delivery group. Methods: A prospective cohort study was conducted in enrolled 158 pregnant women at 18-24 weeks of gestation who come for second trimester scan consecutively. Transvaginal ultrasonography for cervical length as well as cervical elasticity in five regions of interest was performed. Intraobserver and interobserver reproducibility were evaluated. Gestational age at deliveries was followed, and cervical shear wave elasticity between term and preterm group was compared. Results: A total of 158 pregnant women were enrolled in this study while 120 pregnancies data were collected for subsequent analysis, 10 pregnancies spontaneously delivered during the preterm period and 110 pregnancies delivered at term. Intraobserver and interobserver reproducibility were high; however, cervical shear wave elasticity in both groups were not significantly different (external anterior lip 2.29 AE 0.66 and 2.45 AE 0.58 m/s, P value 0.30, internal anterior lip 2.74 AE 0.96 and 2.80 AE 0.61 m/s, P value 0.83). Nonsignificant correlations of cervical shear wave elasticity with gestational age and cervical length (r = −0.1 and r = 0.02, respectively) were demonstrated. Conclusion: Cervical shear wave elasticity in preterm and term groups was not significantly different when measured at 18-24 weeks of gestation. There are nonsignificant correlations between cervical shear wave elasticity, gestational age and cervical length. Cervical shear wave elastography alone should not be used as a predictor for preterm delivery.

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“…Several studies have investigated the predictability of preterm birth using cervical elastography in mid-pregnancy. Table 2 summarizes 5 recent articles that assessed the use of strain elastography of the cervix to predict spontaneous preterm birth [ 20 21 22 23 24 ]. These studies evaluated a larger area than that used in labor induction, by analyzing several ROIs ( Fig.…”

Section: Current Use Of Cervical Elastographymentioning

confidence: 99%

Elastographic measurement of the cervix during pregnancy: Current status and future challenges

Kim

Hwang

2017

Obstet Gynecol Sci

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The cervix is a cylindrical structure that is proximally connected to the uterus and distally to the vaginal cavity. The Bishop score has been used to evaluate the cervix during pregnancy. However, alternatives have been evaluated because the Bishop score is uncomfortable for patients, relies on a subjective examination, and lacks internal os data. Elastography has been used to assess the cervix, as it can estimate tissue stiffness. Recent articles on elastography for cervical assessment during pregnancy have focused on its usefulness for prediction of preterm birth and successful labor induction. There is a clinical need for cervical elastography, as an evaluation of biomechanical factors, because cervical length only assesses morphological changes. However, until now, cervical elastography has been studied in the limited field, and not shown a uniformed methodological technique. In this review, the current status, limitations, and future possibility of cervical elastography were discussed. Future studies should focus on overcoming the limitations of cervical elastography. Although the cervical elastography is presently an incompletely defined technique, it needs to be improved and evaluated as a method for use in combination with cervical length.

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Strain at the internal cervical os assessed with quasi-static elastography is associated with the risk of spontaneous preterm delivery at ≤34 weeks of gestation

Cited by 41 publications

References 89 publications

Cervical elastography during pregnancy: clinical perspectives

Cervical elastography during pregnancy: clinical perspectives

Cervical shear wave elastography as a predictor of preterm delivery during 18–24 weeks of pregnancy

Elastographic measurement of the cervix during pregnancy: Current status and future challenges

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