A soft cervix, categorized by shear-wave elastography, in women with short or with normal cervical length at 18–24 weeks is associated with a higher prevalence of spontaneous preterm delivery

Hernández‐Andrade, Edgar; Maymon, Eli; Luewan, Suchaya; Bhatti, Gaurav; Mehrmohammadi, Mohammad; Erez, Offer; Pacora, Percy; Done, Bogdan; Hassan, Sonia S.; Romero, Roberto

doi:10.1515/jpm-2018-0062

Cited by 62 publications

(69 citation statements)

References 88 publications

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“…Subsequent studies; however, by Hernandez‐Andrade et al . and other authors demonstrated that when pregnancy progresses, cervix becomes shorter and softer; furthermore, a short cervix tends to be soft …”

Section: Discussionmentioning

confidence: 82%

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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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Section: Discussionmentioning

confidence: 82%

“…We compared this study with two relevant studies, the first one by Muller et al . and the latter by Hernandez‐Andrade et al . In our study, the gestational age was limited to 18–24 weeks which is the time when cervical length measurement should be performed (similar to Hernandez‐Andrade et al .).…”

Section: Discussionmentioning

confidence: 99%

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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“…We identified 11 clinical studies in the last three years, which tested the hypothesis that cervical elastography may be useful in predicting preterm delivery [20]- [25] [34] [35] [36] [37] [38]. Of the eleven studies identified, seven used strain ultrasound [20]- [25] [35] and four used shear wave ultrasound [34] [36] [37] [38]. These studies assessed between 30 and 628 subjects with a total of 1901 women in the eleven studies.…”

Section: Discussionmentioning

confidence: 99%

“…Strain ultrasound elastography determines only the relative values of tissue elasticity because the applied transducer pressure is unknown. The shear wave ultrasound elastography provides, in principle at least, a more objective description of tissue elasticity; however, the cervical elasticity is described as a shear wave speed [34] [36] [37] [38], but not as Young's modulus which requires solution of the inverse mechanical problem in absence of stress data. There are several difficulties in using this approach: 1) cervical tissue heterogeneity implies distortions in the shear wave elasticity estimates, 2) placing a transducer next to the cervix is likely to cause a tissue deformation, thereby causing a non-controllable increase in the tissue stiffening, 3) any movement should be avoided for 3 -5 seconds with a shear wave transducer, and 4) it requires a special transducer [39].…”

Section: Discussionmentioning

confidence: 99%

“…The study of all ten women was successful. The recorded ultrasound signals had an identifiable peak amplitude reflected from the cervix's internal os to allow reproducible measurement of ultrasound time-of-flight (see sector on pregnant women was assessed with an intraclass correlation coefficient (ICC), as the correlation between any two measurements made on the same subject [34]. ICC for cervix elasticity was found to be 0.97 and for a cervical length of 0.93 (see Figure 4).…”

Section: Study With Pregnant Womenmentioning

confidence: 99%

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Cervical Characterization with Tactile-Ultrasound Probe

Egorov¹,

Rosen

Raalte³

et al. 2020

OJOG

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Background: Premature cervical softening and shortening may be considered an early mechanical failure that predisposes to preterm birth. Preliminary clinical studies demonstrate that cervical elastography may be able to quantify this phenomenon and predict spontaneous preterm delivery. Objective: To explore a new approach for cervix elasticity and length measurements with tactile-ultrasound probe. Methods: Cervix probe has tactile array and ultrasound transducer designed to apply controllable load to cervix and acquire stress-strain data for calculation of cervical elasticity (Young's modulus) and cervical length for four cervix sectors. Average values, standard deviations, intraclass correlation coefficients and the 95% limits of agreement (Bland-Altman plots) were estimated. Results: Ten non-pregnant and ten pregnant women were examined with the probe. The study with non-pregnant women demonstrated a reliable acquisition of the tactile signals. The ultrasound signals had a prolonged appearance; identification of the internal os of the cervix in these signals was not reliable. The study with pregnant women with the gestational age of 25.4 ± 2.3 weeks demonstrated reliable data acquisition with real-time visualization of the ultrasound signals. Average values for cervical elasticity and standard deviations of 19.7 ± 15.4 kPa and length of 30.7 ± 6.6 mm were calculated based on two measurements per 4 sectors. Measurement repeatability calculated as intraclass correlation coefficients between two measurements at the same cervix sector on pregnant women was found to be 0.97 for cervical elasticity and 0.93 for the cervical length. The 95% limits of agreement of 1) cervical elasticity were from −22.4% to +14.9%, and 2) cervical length from −13.3% to +16.5%. Conclusions: This study demonstrated clinically acceptable measurement performance and reproducibility. The availability of stress-strain data allowed the computation of cervical elasticity and length. This approach has the potential to provide cervical markers to predict spontaneous preterm delivery.

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Use of shear wave elastography on the maternal cervix to recognise cervical insufficiency using a transabdominal ultrasound approach

O'Hara

Zelesco

Sun

2020

Australas J Ultrason Med

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Introduction: The ramifications of preterm birth on society and the role of cervical length in identifying cervical insufficiency are well known. The main goal of this work was to apply shear wave elastography to the maternal cervix to assess the stiffness of the cervix and identify cervical insufficiency, using a transabdominal ultrasound approach. Methods: Measurements of shear wave speed were obtained using a transabdominal ultrasound approach, at the anterior and posterior portions of the internal and external cervical os on 504 participants. A total of 455 participants were contacted following the expected date of birth of the fetus and birth details were obtained. Results: The anterior and posterior portions of the internal os showed a significant correlation between shear wave speed and time until delivery of the fetus for women who gave birth spontaneously, with R 2 Linear being 0.024 (P = 0.012) and 0.017 (P = 0.05) respectively, and these correlations increased for the group of participants that were scanned between the 18th and end of the 20th week of pregnancy to R 2 Linear = 0.043 (P = 0.001) and 0.021 (P = 0.040) respectively. A ratio of internal os/ external os anteriorly also showed a correlation of R 2 Linear = 0.030 (P = 0.009). Conclusion:A transabdominal ultrasound technique has identified a reduction in shear wave speeds at the internal os in the midtrimester, in women who had a subsequent preterm birth.

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A soft cervix, categorized by shear-wave elastography, in women with short or with normal cervical length at 18–24 weeks is associated with a higher prevalence of spontaneous preterm delivery

Abstract: A soft cervix at 18-24 weeks of gestation increases the risk of sPTD <37 and <34 weeks of gestation independently of cervical length.

Cited by 62 publications

References 88 publications

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

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

Cervical Characterization with Tactile-Ultrasound Probe

Use of shear wave elastography on the maternal cervix to recognise cervical insufficiency using a transabdominal ultrasound approach

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