CELASTO (Cervical ELASTOgraphy) pilot study — the use of cervical elastography during pregnancy

Abstract

BACKGROUND: Ultrasound assessment of cervical length is an integral part of a comprehensive examination during pregnancy, but it does not provide a complete picture of structural changes in the cervix. The use of E-Cervix elastography is a promising method to assess cervical remodeling throughout the gestation period.

AIM: The aim of this study was to evaluate the possibility of using automated cervical elastography in clinical practice to analyze the main parameters of cervical elasticity and hardness in pregnancy.

MATERIALS AND METHODS: This prospective pilot study included 136 patients with singleton pregnancies at gestational ages ranging from 7⁺⁰ to 41⁺⁰ weeks. Cervical elastography was performed using E-Cervix software of the W10 diagnostic ultrasound system (Samsung Medison Co., Ltd., South Korea) with evaluation of quantitative parameters such as hardness ratio, elasticity contrast index, internal os, external os.

RESULTS: Correlation analysis showed that hardness ratio decreased with increasing gestational age (ρ = −0.439) and decreasing cervical length (ρ = 0.408; p < 0.001). In the group of patients with cervical length less than 25 mm, there was a decrease in hardness ratio compared to the control group (48.0 vs. 63.8%, respectively; p < 0.001). The elasticity contrast index score, which reflects cervical tissue heterogeneity, increased with gestational age and cervical shortening (ρ = 0.368 and −0.450, respectively), the parameter being higher in patients with cervical length less than 25 mm [4.73 (IQR 4.21–5.90); p < 0.001]. The increase in internal os and external os with gestational age (ρ = 0.433 and ρ = 0.365, respectively; p < 0.001) indicates softening of the cervix and is accompanied by its shortening.

CONCLUSIONS: Results indicate decreased hardness and increased elasticity of the cervix with increasing gestational age and decreased cervical length. E-Cervix technology allows for assessing structural changes in the cervix throughout pregnancy, starting from early gestation.

Keywords

cervix / cervical elastography / cervical ripening / E-cervix

References

[1] Pachuliia OV, Khalenko VV, Shengeliia MO, et al. Biomechanisms of cervical remodeling and current approaches to maturity assessment. Journal of Obstetrics and Women’s Diseases. 2023;72(1):81–95. EDN: SZDEIG doi: 10.17816/JOWD114934

[2] Пачулия О.В., Халенко В.В., Шенгелия М.О., и др. Биомеханизмы ремоделирования шейки матки и современные подходы к оценке степени ее зрелости // Журнал акушерства и женских болезней. 2023. Т. 72, № 1. С. 73–87. EDN: SZDEIG doi: 10.17816/JOWD114934

[3] Coutinho CM, Sotiriadis A, Odibo A, et al. ISUOG practice guidelines: role of ultrasound in the prediction of spontaneous preterm birth. Ultrasound Obstet Gynecol. 2022;60(3):435–456. doi: 10.1002/uog.26020

[4] Coutinho C.M., Sotiriadis A., Odibo A., et al. ISUOG Practice guidelines: role of ultrasound in the prediction of spontaneous preterm birth // Ultrasound Obstet Gynecol. 2022. Vol. 60, N 3. P. 435–456. doi: 10.1002/uog.26020

[5] Mlodawski J, Mlodawska M, Plusajska J, et al. Repeatability and reproducibility of potential ultrasonographic bishop score parameters. J Clin Med. 2023;12(13):4492. doi: 10.3390/jcm12134492

[6] Mlodawski J., Mlodawska M., Plusajska J., et al. Repeatability and reproducibility of potential ultrasonographic bishop score parameters // J Clin Med. 2023. Vol. 12, N. 13. P. 4492. doi: 10.3390/jcm12134492

[7] Faltin-Traub EF, Boulvain M, Faltin DL, et al. Reliability of the Bishop score before labour induction at term. Eur J Obstet Gynecol Reprod Biol. 2004;112(2):178–181. doi: 10.1016/s0301-2115(03)00336-1

[8] Faltin-Traub E.F., Boulvain M., Faltin D.L., et al. Reliability of the Bishop score before labour induction at term // Eur J Obstet Gynecol Reprod Biol. 2004. Vol. 112, N. 2. P. 178–181. doi: 10.1016/s0301-2115(03)00336-1

[9] Seol HJ, Sung JH, Seong WJ, et al. Standardization of measurement of cervical elastography, its reproducibility, and analysis of baseline clinical factors affecting elastographic parameters. Obstet Gynecol Sci. 2020;63(1):42–54. doi: 10.5468/ogs.2020.63.1.42

[10] Seol H.J., Sung J.H., Seong W.J., et al. Standardization of measurement of cervical elastography, its reproducibility, and analysis of baseline clinical factors affecting elastographic parameters // Obstet Gynecol Sci. 2020. Vol. 63, N. 2. P. 42–54. doi: 10.5468/ogs.2020.63.1.42

[11] Swiatkowska-Freund M, Traczyk-Łoś A, Preis K, et al. Prognostic value of elastography in predicting premature delivery. Ginekol Pol. 2014;85(3):204–207. doi: 10.17772/gp/1714

[12] Światkowska-Freund M., Traczyk-łoś A., Preis K., et al. Prognostic value of elastography in predicting premature delivery // Ginekol. Pol. 2014. Vol. 85, N. 3. P. 204–207. doi: 10.17772/gp/1714

[13] Liu Y, Yang D, Jiang Y, et al. Quantification of cervical stiffness changes in single and twin pregnancies using the E-Cervix technique. Am J Obstet Gynecol MFM. 2023;5(2). doi: 10.1016/j.ajogmf.2022.100804

[14] Liu Y., Yang D., Jiang Y., et al. Quantification of cervical stiffness changes in single and twin pregnancies using the E-Cervix technique // Am J Obstet Gynecol MFM. 2023. Vol. 5, N. 2. doi: 10.1016/j.ajogmf.2022.100804

[15] Du L, Lin MF, Wu LH, et al. Quantitative elastography of cervical stiffness during the three trimesters of pregnancy with a semiautomatic measurement program: a longitudinal prospective pilot study. J Obstet Gynaecol Res. 2020;46(2):237–248. doi: 10.1111/jog.14170

[16] Du L., Lin M.F., Wu L.H., et al. Quantitative elastography of cervical stiffness during the three trimesters of pregnancy with a semiautomatic measurement program: A longitudinal prospective pilot study // J Obstet Gynaecol Res. 2020. Vol. 46, N. 2. P. 237–248. doi: 10.1111/jog.14170

[17] Nazzaro G, Saccone G, Miranda M, et al. Cervical elastography using E-cervix for prediction of preterm birth in singleton pregnancies with threatened preterm labor. J Matern Fetal Neonatal Med. 2022;35(2):330–335. doi: 10.1080/14767058.2020.1716721

[18] Nazzaro G., Saccone G., Miranda M., et al. Cervical elastography using E-cervix for prediction of preterm birth in singleton pregnancies with threatened preterm labor // J Matern Fetal Neonatal Med. 2022. Vol. 35, N. 2. P. 330–335. doi: 10.1080/14767058.2020.1716721

[19] Patberg ET, Wells M, Vahanian SA, et al. Use of cervical elastography at 18 to 22 weeks’ gestation in the prediction of spontaneous preterm birth. Am J Obstet Gynecol. 2021;225(5):525.e1–525.e9. doi: 10.1016/j.ajog.2021.05.017

[20] Patberg E.T., Wells M., Vahanian S.A., et al. Use of cervical elastography at 18 to 22 weeks’ gestation in the prediction of spontaneous preterm birth // Am J Obstet Gynecol. 2021. Vol. 225, N. 5. P. 525.e1–525.e9. doi: 10.1016/j.ajog.2021.05.017

[21] Zhou Y, Jin N, Chen Q, et al. Predictive value of cervical length by ultrasound and cervical strain elastography in labor induction at term. J Int Med Res. 2021;49(2). doi: 10.1177/0300060520985338

[22] Zhou Y., Jin N., Chen Q., et al. Predictive value of cervical length by ultrasound and cervical strain elastography in labor induction at term // J Int Med Res. 2021. Vol. 49, N. 2. doi: 10.1177/0300060520985338

[23] Seol HJ, Sung JH, Seong WJ, et al. Standardization of measurement of cervical elastography, its reproducibility, and analysis of baseline clinical factors affecting elastographic parameters. Obstet Gynecol Sci. 2020;63(1):42–54. doi: 10.5468/ogs.2020.63.1.42

[24] Seol H.J., Sung J.H., Seong W.J., et al. Standardization of measurement of cervical elastography, its reproducibility, and analysis of baseline clinical factors affecting elastographic parameters // Obstet Gynecol Sci. 2020. Vol. 63, N. 1. P. 42–54. doi: 10.5468/ogs.2020.63.1.42

[25] To MS, Skentou C, Chan C, et al. Cervical assessment at the routine 23-week scan: standardizing techniques. Ultrasound Obstet Gynecol. 2001;17(3):217–219. doi: 10.1046/j.1469-0705.2001.00369.x

[26] To M.S., Skentou C., Chan C., et al. Cervical assessment at the routine 23-week scan: standardizing techniques // Ultrasound Obstet Gynecol. 2001. Vol. 17, N. 3. P. 217–219. doi: 10.1046/j.1469-0705.2001.00369.x

[27] Park HS, Kwon H, Kwon JY, et al. Uterine cervical change at term examined using ultrasound elastography: a longitudinal study. J Clin Med. 2020;10(1):75. doi: 10.3390/jcm10010075

[28] Park H.S., Kwon H., Kwon J.Y., et al. Uterine cervical change at term examined using ultrasound elastography: a longitudinal study // J Clin Med. 2020. Vol. 10, N. 1. P. 75. doi: 10.3390/jcm10010075

[29] Myers K, Socrate S, Tzeranis D, et al. Changes in the biochemical constituents and morphologic appearance of the human cervical stroma during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2009;144(Suppl 1):S82–S89. doi: 10.1016/j.ejogrb.2009.02.008

[30] Myers K., Socrate S., Tzeranis D., et al. Changes in the biochemical constituents and morphologic appearance of the human cervical stroma during pregnancy // Eur J Obstet Gynecol Reprod Biol. 2009. Vol. 144, N. 1(suppl.). P. S82–S89. doi: 10.1016/j.ejogrb.2009.02.008

[31] Nazzaro G, Saccone G, Miranda M, et al. Cervical elastography using E-cervix for prediction of preterm birth in singleton pregnancies with threatened preterm labor. J Matern Fetal Neonatal Med. 2022;35(2):330–335. doi: 10.1080/14767058.2020.1716721

[32] Nazzaro G., Saccone G., Miranda M., et al. Cervical elastography using E-cervix for prediction of preterm birth in singleton pregnancies with threatened preterm labor // J Matern Fetal Neonatal Med. 2022. Vol. 35, N. 2. P. 330–335. doi: 10.1080/14767058.2020.1716721

[33] Mlodawski J, Mlodawska M, Plusajska J, et al. Repeatability and reproducibility of quantitative cervical strain elastography (E-Cervix) in pregnancy. Sci Rep. 2021;11(2):162–167. doi: 10.1038/s41598-021-02498-3

[34] Mlodawski J., Mlodawska M., Plusajska J., et al. Repeatability and reproducibility of quantitative cervical strain elastography (E-Cervix) in pregnancy // Sci Rep. 2021. Vol. 11, N. 1. P. 23689. doi: 10.1038/s41598-021-02498-3

[35] Fruscalzo A, Schmitz R, Klockenbusch W, et al. Reliability of cervix elastography in the late first and second trimester of pregnancy. Ultraschall Med. 2012;33(7):E101–E107. doi: 10.1055/s-0031-1299330

[36] Fruscalzo A., Schmitz R., Klockenbusch W., et al. Reliability of cervix elastography in the late first and second trimester of pregnancy // Ultraschall Med. 2012. Vol. 33, N. 7. P. E101–E107. doi: 10.1055/s-0031-1299330

[37] Zhang L, Zheng Q, Xie H, et al. Quantitative cervical elastography: a new approach of cervical insufficiency prediction. Arch Gynecol Obstet. 2020;301(1):207–215. doi: 10.1007/s00404-019-05377-5

[38] Zhang L., Zheng Q., Xie H., et al. Quantitative cervical elastography: a new approach of cervical insufficiency prediction // Arch Gynecol Obstet. 2020. Vol. 301, N. 1. P. 207–215. doi: 10.1007/s00404-019-05377-5

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