Use of cervical elastography at 18 to 22 weeks’ gestation in the prediction of spontaneous preterm birth

Patberg, Elizabeth; Wells, Michael; Vahanian, Sevan A.; Zavala, Jose; Bhattacharya, Sarmistha; Richmond, Diana S.; Akerman, Meredith; Demishev, Michael; Kinzler, Wendy L.; Chavez, Martin; Vintzileos, Anthony M.

doi:10.1016/j.ajog.2021.05.017

Cited by 27 publications

(26 citation statements)

References 33 publications

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“…Cervical length decreases as pregnancy progresses [ 25 ] and was not traditionally considered to be predictive of a successful vaginal delivery or cervical ripening [ 26 ]. The functional cervical length can be measured using the E-Cervix system and a four-point ROI that traces the endocervical lining of a straight or curved cervix [ 27 ]. The accuracy and repeatability of cervical length measurements have been improved using semi-automatic systems, and cervical length has become a valuable parameter for predicting the success of IOL [ 13 , 28 – 31 ].…”

Section: Discussionmentioning

confidence: 99%

Prediction model for successful induction of labor by cervical strain elastography diagnosed at late-term pregnancy in nulliparous women: a prospective cohort study

Yang

Zhou

Chen

et al. 2023

BMC Pregnancy Childbirth

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Background The use of cervical strain elastography for nulliparous women during late-term pregnancy remains unclear. This study assesses the predictive value of late-term cervical strain elastography for successful induction of labor (IOL) in nulliparous women. Methods This single-centered, prospective study included 86 patients undergoing IOL between January 2020 and March 2022. Univariate and multivariate analyses were conducted to identify predictive factors for successful IOL. The predictive values were assessed using the area under receiver operating characteristic (ROC) curves. Results IOL was successful in 58 patients. The hardness ratio and cervical length were significantly associated with successful late-term IOL in nulliparous women. The predictive value of the combination of hardness ratio and cervical length was higher than that of cervical length alone. Conclusions The hardness ratio and cervical length assessed by cervical strain elastography during late-term pregnancy are predictors of the success of IOL in nulliparous women. The predictive value of the combination of hardness ratio and cervical length was higher than that of cervical length alone.

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Section: Discussionmentioning

confidence: 99%

Prediction model for successful induction of labor by cervical strain elastography diagnosed at late-term pregnancy in nulliparous women: a prospective cohort study

Yang

Zhou

Chen

et al. 2023

BMC Pregnancy Childbirth

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“… 18–20 However, most studies have concentrated on determining the accuracy of cervical elastography in predicting SPTD (alone or in combination with CL), rather than proposing a practical approach for screening possible SPTD according to the measured CL and elastic data. 21–23 Therefore, we developed a nomogram (an easily applicable prediction model) containing CL and elastic data to predict SPTD.…”

Section: Discussionmentioning

confidence: 99%

Nomogram Incorporating Multimodal Transvaginal Ultrasound Assessment at 20 to 24 Weeks’ Gestation for Predicting Spontaneous Preterm Delivery in Low-Risk Women

Jiang¹,

Peng²,

Rong³

et al. 2022

IJWH

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Background The majority of women who experience spontaneous preterm delivery (SPTD) have low-risk, asymptomatic pregnancies with a cervical length (CL) ≥25mm and no clear risk factors. Despite the fact that cervical elastography is a potential tool for predicting SPTD, there is currently no feasible solution to make a reliable prediction for preventing SPTD. Objective The aim of this study was to construct a nomogram including multimodal transvaginal ultrasound parameters during the second trimester to predict SPTD in low-risk women. Methods This multi-center study enrolled 1260 women with singleton pregnancies between 20 and 24 weeks’ gestation. CL and cervical elastography data were obtained when they were undergoing the second-trimester anomaly scan. Univariate and multivariate Logistic regression were utilized to screen predictors independently related to SPTD from the maternal characteristics and multimodal ultrasound data. Then construct a nomogram to determine the likelihood of SPTD in pregnant women. Results A total of 66 pregnancies in the training cohort (7.8%, 66/842) and 37 pregnancies (8.9%, 37/418) in the validation cohort ended in SPTD. Age, uterine curettage, CL, and strain in the anterior lip of internal os were the independent predictors of SPTD ( P < 0.001, < 0.001, = 0.007, and < 0.001, respectively). These predictors constituted a nomogram to predict the probability of SPTD for a pregnant woman in her second trimester. It showed good discrimination (C-index = 0.898 and 0.839), calibration ( P = 0.258 and 0.115), and yielded net benefits both in the training and validation cohorts. Conclusion The nomogram including data of multimodal transvaginal ultrasound at 20 to 24 weeks’ gestation is expected to identify women with SPTD in the low-risk, asymptomatic population.

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“…Our study also demonstrated that the elastographic parameters of ECI and HR were significantly different between the sPTD and TD groups of the LEEP group. ECI and HR were also recently identified as important parameters for predicting sPTD 14 , 15 , 23 . Patberg et al reported that an increasing ECI at 18–22 weeks was an independent risk factor for sPTD in singleton pregnancies 14 .…”

Section: Discussionmentioning

confidence: 99%

“…ECI and HR were also recently identified as important parameters for predicting sPTD 14 , 15 , 23 . Patberg et al reported that an increasing ECI at 18–22 weeks was an independent risk factor for sPTD in singleton pregnancies 14 . Park et al suggested that addition of ECI might improve the sPTD predictive ability in women with a CL of 1.5–2.5 cm 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Elastography has recently emerged as a promising ancillary tool to conventional ultrasound since it enables assessment of the mechanical properties of tissue and the stiffness as a strain value of the organs, including the breast and liver 12 , 13 . Effort is underway worldwide to introduce cervical elastography in the obstetric area to evaluate the cervix during pregnancy 14 – 20 . Studies have shown that cervical elastography could be an effective tool for assessment of women at risk of sPTD 15 , 21 – 27 .…”

Section: Introductionmentioning

confidence: 99%

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Midtrimester cervical elastography in pregnant women with a history of loop electrosurgical excision procedure (LEEP)

Cha

Seong

Kim

et al. 2022

Sci Rep

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We aimed to compare cervical elastographic parameters based on a previous loop electrosurgical excision procedure (LEEP) and to determine whether they can predict preterm delivery in pregnant women with a history of LEEP. This multicenter prospective case–control study included 71 singleton pregnant women at 14–24 weeks of gestation with a history of LEEP and 1:2 gestational age-matched controls. We performed cervical elastography using E-cervix and compared maternal characteristics, delivery outcomes, cervical length (CL), and elastographic parameters between the two groups. The median mid-trimester CL was significantly shorter in the LEEP group. Most elastographic parameters, including internal os (IOS), external os (EOS), elasticity contrast index (ECI), and hardness ratio (HR), were significantly different in the two groups. In the LEEP group, the sPTD group compared to the term delivery (TD) group showed a higher rate of previous sPTD (50% vs. 1.7%, p < 0.001), higher IOS and ECI (IOS: 0.28 [0.12–0.37] vs. 0.19 [0.10–0.37], p = 0.029; ECI: 3.89 [1.79–4.86] vs. 2.73 [1.48–5.43], p = 0.019), and lower HR (59.97 [43.88–92.43] vs. 79.06 [36.87–95.40], p = 0.028), but there was no significant difference in CL (2.92 [2.16–3.76] vs. 3.13 [1.50–3.16], p = 0.247). In conclusion, we demonstrated that a history of LEEP was associated with a change in cervical strain measured in mid-trimester as well as with CL shortening. We also showed that cervical elastography can be useful in predicting sPTD in pregnant women with previous LEEP.

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Use of cervical elastography at 18 to 22 weeks’ gestation in the prediction of spontaneous preterm birth

Cited by 27 publications

References 33 publications

Prediction model for successful induction of labor by cervical strain elastography diagnosed at late-term pregnancy in nulliparous women: a prospective cohort study

Prediction model for successful induction of labor by cervical strain elastography diagnosed at late-term pregnancy in nulliparous women: a prospective cohort study

Nomogram Incorporating Multimodal Transvaginal Ultrasound Assessment at 20 to 24 Weeks’ Gestation for Predicting Spontaneous Preterm Delivery in Low-Risk Women

Midtrimester cervical elastography in pregnant women with a history of loop electrosurgical excision procedure (LEEP)

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