Evaluation of cervical stiffness during pregnancy using semiquantitative ultrasound elastography

Abstract

Objective To evaluate cervical stiffness during pregnancy using ultrasound-derived elastography, a method used to estimate the average tissue displacement (strain) on a defined region of interest when oscillatory compression is applied. Methods Strain was calculated in two regions of interest, the endocervical canal and the entire cervix, from three anatomical planes of the cervix: mid-sagittal in the plane used for cervical length measurement, and in cross-sectional planes located at the internal and external cervical os. Associations between strain values, method of ascertainment and patient characteristics were assessed using linear mixed models to account for within-subject correlation. Inter-rater agreement in defining the degree of cervical stiffness was evaluated in 120 regions of interest acquired by two operators in 20 patients. Results A total of 1557 strain estimations were performed in 262 patients at 8-40 weeks of gestation. Adjusting for other sources of variation, 1) cervical tissue strain estimates obtained in the endocervical canal were on average 33% greater than those obtained in the entire cervix; 2) measures obtained in the cross-sectional plane of the external cervical os and sagittal plane were 45% and 13% greater compared to those measured in the cross-sectional plane of the internal cervical os, respectively; 3) mean strain rate was 14% and 5% greater among multiparous women with and without a history of preterm delivery compared to nulliparous women, respectively, and was on average 13% greater among women with a cervical length between 25-30mm compared to those with a cervical length >30mm; and 4) cervical tissue strain was more strongly associated with cervical length than with gestational age. Conclusion Semiquantitative elastography can be employed to evaluate changes in cervical stiffness during pregnancy.

Diagnostic accuracy of cervical elastography in predicting labor induction success: a systematic review and meta-analysis

“…This new ultrasound tool aims to allow an objective evaluation of the cervical stiffness, thus potentially replacing the current subjective evaluation by digital palpation. Several approaches have been proposed with encouraging preliminary results, and now clinical studies evaluating the effectiveness of cervical elastography in predicting preterm delivery [12][13][14][15][16] and a successful labor induction are rapidly increasing [8,[17][18][19][20][21][22][23][24]. We performed this meta-analysis to assess the accuracy of cervix elastography in predicting labor induction success.…”

Differentiating untreated and cross-linked porcine corneas of the same measured stiffness with optical coherence elastography

“…7 Similar to ultrasound elastography (USE) 8 and magnetic resonance elastography (MRE), 9 OCE is usually composed of an external loading component that produces displacements within the tissue. In OCE, imaging this tissue displacement is performed with optical coherence tomography (OCT), which has superior spatial resolution compared with USE and MRE.…”

Preterm labor and preterm birth

“…In Central Europe, the rate of preterm deliveries varies between 5% and 11% [10]. After conization, the rate of preterm deliveries increases to 26% [6,10,11]. Depending on the extent of conization, every resected millimeter increases the rate by approximately 6% [11].…”

“…After conization, the rate of preterm deliveries increases to 26% [6,10,11]. Depending on the extent of conization, every resected millimeter increases the rate by approximately 6% [11]. In patients who are treated using radical trachelectomy, a permanent cerclage is inserted to imitate the function of the cervix and to maintain a certain uterine stabilization for a following pregnancy.…”

“…Breastfed infants have better feeding tolerance and neural development. As breast milk alone does not satisfy the nutritional needs of premature infants, the use of milk fortifiers is recommended, especially in premature infants less than 2000 g [11]. Alizadeh Taheri et al [17] conducted a double-blind randomized study on this formulation.…”