Objective
To determine if there is an association between cervical strain, evaluated using ultrasound elastography, and spontaneous preterm delivery (sPTD) <37 weeks of gestation.
Methods
One hundred and eighty nine (189) women at 16–24 weeks of gestation were evaluated. Ultrasound elastography was used to estimate cervical strain in three anatomical planes: one mid-sagittal in the same plane used for cervical length measurement, and two cross sectional images: one at the level of the internal cervical os, and the other at the level of the external cervical os. In each plane, two regions of interest (endocervix and entire cervix) were examined; a total of six regions of interest were evaluated.
Results
The prevalence of sPTD was 11% (21/189). Strain values from each of the six cervical regions correlated weakly with cervical length (r= −0.24, p<0.001 to r= −0.03, p=0.69). Strain measurements obtained in a cross sectional view of the internal cervical os were significantly associated with sPTD. Women with strain values ≤25th centile in the endocervical canal (0.19) and in the entire cervix (0.14) were 80% less likely to have a sPTD than women with strain values >25th centile (endocervical: odds ratio [OR] 0.2; 95% confidence interval [CI], 0.03–0.96; entire cervix: OR 0.17; 95% CI, 0.03–0.9). Additional adjustment for gestational age, race, smoking status, parity, maternal age, pre-pregnancy body mass index and previous preterm delivery did not appreciably alter the magnitude or statistical significance of these associations. Strain values obtained from the external cervical os and from the sagittal view were not associated with sPTD.
Conclusion
Low strain values in the internal cervical os were associated with a significantly lower risk of spontaneous preterm delivery <37 weeks of gestation.
Aim
To investigate the effect of depth on cervical shear-wave elastography.
Methods
Shear-wave elastography was applied to estimate the velocity of propagation of the acoustic force impulse (shear-wave) in the cervix of 154 pregnant women at 11-36 weeks of gestation. Shear-wave speed (SWS) was evaluated in cross-sectional views of the internal and external cervical os in five regions of interest: anterior, posterior, lateral right, lateral left, and endocervix. Distance from the center of the US transducer to the center of the each region of interest was registered.
Results
In all regions, SWS decreased significantly with gestational age (p=0.006). In the internal os SWS was similar among the anterior, posterior and lateral regions, and lower in the endocervix. In the external os, the endocervix and anterior regions showed similar SWS values, lower than those from the posterior and lateral regions. In the endocervix, these differences remained significant after adjustment for depth, gestational age and cervical length. SWS estimations in all regions of the internal os were higher than those of the external os, suggesting denser tissue.
Conclusion
Depth from the ultrasound probe to different regions in the cervix did not significantly affect the SWS estimations.
The lesion termed ‘placental infarction hematoma' is associated with fetal death and adverse perinatal outcome. Such a lesion has been associated with a high risk of fetal death and abruption placentae. The fetal and placental hemodynamic changes associated with placental infarction hematoma have not been reported. This paper describes a case of early and severe growth restriction with preeclampsia, and progressive deterioration of the fetal and placental Doppler parameters in the presence of a placental infarction hematoma.
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