Evaluation of Cervical Elastography Strain Pattern to Predict Preterm Birth

2019 ◽  
Vol 41 (04) ◽  
pp. 397-403
Author(s):  
Anna Gesthuysen ◽  
Kerstin Hammer ◽  
Mareike Möllers ◽  
Janina Braun ◽  
Kathrin Oelmeier de Murcia ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Area Under The Curve ◽  
Predictive Marker ◽  
Strain Ratio ◽  
Cervical Length ◽  
Strain Pattern ◽  
Spontaneous Preterm Delivery ◽  
Index Strain ◽  
Normal Controls ◽  
Control Study

Abstract Purpose To evaluate cervical elastography strain pattern as a predictive marker for spontaneous preterm delivery (SPTD). Materials and Methods In this case-control study cervical length (CL) and elastographic data (strain ratio, elastography index, strain pattern score) were acquired from 335 pregnant women (20th – 34th week of gestation) by transvaginal ultrasound. Data of 50 preterm deliveries were compared with 285 normal controls. Strain ratio and elastography index were calculated by placing two regions of interest (ROIs) in parallel on the anterior cervical lip. The strain ratio was determined by dividing the higher strain value by the lower one. The elastography index was defined as the maximum of the strain ratio curve. Elastographic images were assigned a new established strain pattern (SP) score between 0 and 2 according to the distribution of strain induced by compression. Results Elastography index, SP score and CL differed between preterm and normal pregnancies (1.61 vs. 1.27, p < 0.001; SP score value of “2”: n = 31 (62 %) vs. n = 36 (12.6 %), p < 0.001; CL 30.7 vs. 41.0 mm, p < 0.001; respectively). The elastography index and SP score were associated with a higher predictive potential than CL measurement alone (AUC 0.8059 (area under the curve); AUC 0.7716; AUC 0.7631; respectively). A combination of all parameters proved more predictive than any single parameter (AUC 0.8987; respectively). Conclusion Higher elastography index and SP scores were correlated with an elevated risk of SPTD and are superior to CL measurement as a predictive marker. A combination of these parameters could be used as a “Cervical Index” for the prediction of SPTD.

Assessment of cervical elastography strain pattern and its association with preterm birth

2017 ◽  
Vol 45 (8) ◽  
Author(s):  
Vera Oturina ◽  
Kerstin Hammer ◽  
Mareike Möllers ◽  
Janina Braun ◽  
Maria Karina Falkenberg ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Strain Ratio ◽  
Cervical Length ◽  
Ultrasound Elastography ◽  
Observer Variability ◽  
Spontaneous Preterm Birth ◽  
Predictive Values ◽  
Strain Pattern ◽  
Spontaneous Preterm Delivery

AbstractObjective:The aim of the study was to assess the cervical strain pattern by an ultrasound elastography cervix examination and to determine its association with preterm delivery.Methods:In this study, 30 cases resulting in preterm birth and 30 gestational age-matched controls were included. A vaginal ultrasound examination with cervical length and elastography measurement was performed. We calculated four strain ratios (SR1–SR4) of the regions of interest (ROIs) arranged in pairs in four different positions on the anterior cervical lip. The strain ratios were correlated to the outcome of spontaneous preterm delivery. The inter-observer and intra-observer variability of the strain measurement was evaluated.Results:We observed an association between the value of the strain ratio that was calculated from the ROIs placed side by side in the middle of the anterior lip (SR4), and preterm delivery (P<0.001). The predictive values of cervical length and SR4 were comparable (AUC 0.7394; AUC 0.8322, respectively). The combination of cervical length and SR4 was superior in predicting preterm delivery compared to both parameters alone (AUC 0.8789). The inter-observer and intra-observer variability of data acquisition and measurement was excellent.Conclusions:Our study assesses the cervical elastography strain pattern and shows a correlation to a spontaneous preterm birth.

Cervical elastography strain ratio and strain pattern for the prediction of a successful induction of labour

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Marlit Karen Strobel ◽  
Maria Eveslage ◽  
Helen Ann Köster ◽  
Mareike Möllers ◽  
Janina Braun ◽  
...  
Keyword(s):  
Strain Ratio ◽  
Cervical Length ◽  
Transformation Process ◽  
Induction Of Labour ◽  
Bishop Score ◽  
Cervical Tissue ◽  
Strain Pattern ◽  
Successful Induction ◽  
Study Population ◽  
First Time

AbstractObjectivesThe aim of this study was to introduce cervical strain elastography to objectively assess the cervical tissue transformation process during induction of labour (IOL) and to evaluate the potential of cervical elastography as a predictor of successful IOL.MethodsA total of 41 patients with full-term pregnancies elected for an IOL were included. Vaginal ultrasound with measurement of cervical length and elastography and assessment of the Bishop Score were performed before and 3 h after IOL. The measured parameters were correlated to the outcome of IOL and the time until delivery.ResultsWe observed an association between the strain pattern and the value of the strain ratio 3 h after IOL and a successful IOL (p=0.0343 and p=0.0342, respectively) which can be well demonstrated by the results after 48 h. In our study population the cervical length and the Bishop Score did not prove to be relevant parameters for the prediction of a successful IOL.ConclusionsWe demonstrated for the first time that the cervical elastography pattern after the first prostaglandine application can help predict the outcome of IOL.

scholarly journals Prediction of Spontaneous Preterm Birth in At-risk Women Using Thrombospondin 1 from Cervicovaginal Fluid: A Prospective Observational Study

2021 ◽  
Vol 81 (09) ◽  
pp. 1055-1064
Author(s):  
Johannes Stubert ◽  
Kathleen Gründler ◽  
Bernd Gerber ◽  
Dagmar-Ulrike Richter ◽  
Max Dieterich
Keyword(s):  
At Risk ◽  
Preterm Birth ◽  
Predictive Value ◽  
Transvaginal Ultrasound ◽  
Area Under The Curve ◽  
Cervical Length ◽  
Multiple Gestation ◽  
Spontaneous Preterm Birth ◽  
Thrombospondin 1 ◽  
Cervicovaginal Fluid

Abstract Introduction Thrombospondin 1, desmoplakin and stratifin are putative biomarkers for the prediction of preterm birth. This study aimed to validate the predictive capability of these biomarkers in patients at risk of preterm birth. Materials and Methods We included 109 women with symptoms of threatened spontaneous preterm birth between weeks 20 0/7 and 31 6/7 of gestation. Inclusion criteria were uterine contractions, cervical length of less than 25 mm, or a personal history of spontaneous preterm birth. Multiple gestations were also included. Samples of cervicovaginal fluid were taken before performing a digital examination and transvaginal ultrasound. Levels of cervicovaginal thrombospondin 1, desmoplakin and stratifin were quantified by enzyme-linked immunosorbent assays. The primary endpoint was spontaneous preterm birth before 34 + 0 weeks of gestation. Results Sixteen women (14.7%) delivered before 34 + 0 weeks. Median levels of thrombospondin 1 were higher in samples where birth occurred before 34 weeks vs. ≥ 34 weeks of gestation (4904 vs. 469 pg/mL, p < 0.001). Receiver operator characteristics analysis resulted in an area under the curve of 0.86 (p < 0.0001). At an optimal cut-off value of 2163 pg/mL, sensitivity, specificity, positive predictive value and negative predictive value were 0.94, 0.77, 0.42 and 0.99, respectively, with an adjusted odds ratio of 32.9 (95% CI: 3.1 – 345, p = 0.004). Multiple gestation, cervical length, and preterm labor had no impact on the results. Survival analysis revealed a predictive period of more than eight weeks. Levels of desmoplakin and stratifin did not differ between groups. Conclusion Thrombospondin 1 allowed long-term risk estimation of spontaneous preterm birth.

scholarly journals Association Between Cervical Length at 18-23 Weeks of Gestation and Spontaneous Preterm Delivery: A Cross Sectional Study

2020 ◽  
pp. 1-4
Author(s):  
Trupti Ruge ◽  
Trupti Ruge ◽  
Emanuel Gracias
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Transvaginal Ultrasound ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Cervical Length ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Spontaneous Preterm Delivery

Introduction: Preterm birth is childbirth occurring at less than 37 completed weeks or 259 days of gestation, is a major determinant of neonatal mortality and morbidity and has long-term adverse consequences for health. Identifying ways to address preventable causes of preterm birth should be a top priority in developing regions of the world. the present study was planned to find the association between cervical length at 18 to 23 weeks of gestation done as a routine during all second level scans and spontaneous preterm delivery. Patients and Methods: This is a hospital based cross sectional study conducted during the period from January 2019 to December 2019. A total of 205 women presenting with singleton pregnancies between 18- 23 weeks of gestations were assessed by transvaginal ultrasound for the measurement of cervical length. Patients were interviewed and their demographic data such as age, obstetric index(GPALD), obstetric history such last menstrual period (LMP), estimated delivery date (EDD) and current pregnancy details such as BP, pulse rate, pallor, period of gestation, were recorded in a predesigned pro forma. Results: In a total of 205 subjects, the average age was found to be 23.26 ± 3.49 years with 52.2% of the women being primigravida. The mean gestation age at the time of enrollment was 20.72 ± 1.00 weeks with 33% of women showing a cervical length of 26-30 mm. The delivery outcome was found as 11% preterm, majority (89.27%) was term delivery. Conclusion: The present study showed that a significantly higher number of women with cervical length ≤ 30 mm (assessed at 18 to 23 weeks of gestation) had preterm labour compared to a woman with cervical length > 30 mm.

Cervical Length as a Predictor of Preterm Delivery in an Unselected Cohort of Women with Twin Pregnancies

2018 ◽  
Vol 36 (12) ◽  
pp. 1288-1294 ◽  
Author(s):  
Clifton O. Brock ◽  
Leslie A. Moroz ◽  
Cynthia Gyamfi-Bannerman
Keyword(s):  
Preterm Delivery ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Positive Likelihood Ratio ◽  
Cervical Length ◽  
Prospective Data ◽  
Spontaneous Preterm Delivery ◽  
False Discovery ◽  
Twin Pregnancies ◽  
Unselected Cohort

Objective To determine the risk of spontaneous preterm delivery (SPTD) associated with transvaginal cervical length (TVCL) in an unselected cohort. Study Design This is a retrospective study of serial TVCLs in unselected twin gestations. Receiver operator curves for SPTD were constructed from TVCLs at 18, 20, 22, and 24 weeks. Prediction thresholds were determined using a false discovery rate of 10%. The risk of SPTD was compared with previously published, prospective data from a meta-analysis. Results A total of 1,228 women were included. SPTD occurred prior to 35 weeks in 232 (18.9%), 126 (10.3%), and 24 (2.0%) women prior to 35, 32, and 28 weeks. TVCL was most predictive at 22 weeks (area under the curve = 0.67). TVCL thresholds for predicting SPTD prior to 35, 32, and 28 weeks were 3.1, 3.0, and 2.9 cm. Compared with a previous meta-analysis, the risk of SPTD < 34, 32, and 28 weeks was lower (positive likelihood ratio 9.0 vs. 5.4, 10.1 vs. 5.9, and 9.6 vs. 4.3). Conclusion TVCL is modestly predictive of SPTD in twin gestations. Compared with previous prospective studies, this cohort has lower risk of SPTD at similar TVCLs.

The comparison of USG measured cervical length in pregnant women with previous induced abortion versus those who have not had an induced abortion

2019 ◽  
Vol 8 (10) ◽  
pp. 4024
Author(s):  
Harshita Naidu ◽  
Nivedita Hegde ◽  
Anjali M. ◽  
Rohini Kanniga ◽  
Akhila Vasudeva
Keyword(s):  
Pregnant Women ◽  
Preterm Delivery ◽  
Transvaginal Ultrasound ◽  
Induced Abortion ◽  
Cervical Length ◽  
Care Hospital ◽  
Spontaneous Preterm Delivery ◽  
Increased Risk ◽  
Significant Difference ◽  
History Of

Background: The majority of women who undergo induced abortion are young and of low parity. Hence, it is desirable to look for any association effects of induced abortion with future reproductive outcomes. In this study, we aim to compare ultrasound measured cervical length in pregnant women with previous induced abortion versus those who have not had an induced abortion.Methods: This was a prospective observational study performed at tertiary care hospital. Total of 400 patients were recruited, divided into two groups. Patients with an induced abortion in previous pregnancy were included as cases and those with no history were taken as controls. Cervical length was measured by transvaginal ultrasound in all participants at 11-14, 18-22 and 28-32 weeks. Pregnancies were followed up to note incidence of spontaneous preterm delivery, preterm pre labour rupture of membranes (PPROM), threatened preterm, and second trimester miscarriage.Results: Authors have found that there was no significant difference in the cervical length of pregnant patients with or without a history of prior induced abortions.  In our study authors found that mean cervical length at 11-14weeks, 18-22 weeks, and 28-32 weeks was 3.47±0.126cm and 3.48±0.195cm; 3.44±0.296cm and 3.49±0.182cm; 3.36±0.477cm and 3.42±0.310cm respectively among cases and controls. However, there was a demonstrably increased risk of spontaneous preterm delivery, PPROM and threatened preterm in patients with a history of prior induced abortion.Conclusions: Authors conclude that previous induced abortion increases the risk of threatened preterm, PPROM, spontaneous preterm delivery in the subsequent pregnancy. But, this risk is not predictable by measuring cervical length as the mean cervical length remained the same in both the groups.

scholarly journals VP46.14: Use of transvaginal ultrasound cervical length for prevention of spontaneous preterm delivery and its management

2021 ◽  
Vol 58 (S1) ◽  
pp. 296-297
Author(s):  
I. Pelayo ◽  
J. Sancho ◽  
M. Anton ◽  
L.I. Abarca ◽  
E. Cabezas ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Spontaneous Preterm Delivery

Prediction of Preterm Delivery by Late Cervical Length Measurement after 24 Weeks

2015 ◽  
Vol 38 (3) ◽  
pp. 200-204 ◽  
Author(s):  
Ioannis Papastefanou ◽  
Athanasios Pilalis ◽  
Makarios Eleftheriades ◽  
Athena P. Souka
Keyword(s):  
Preterm Delivery ◽  
Transvaginal Ultrasound ◽  
False Positive Rate ◽  
Cross Sectional Study ◽  
Cervical Length ◽  
Low Risk ◽  
Cross Sectional ◽  
Spontaneous Preterm Delivery ◽  
Positive Rate ◽  
Singleton Pregnancies

Objective: To examine the value of the cervical length (CL) measurement at 24-30 gestational weeks in the prediction of spontaneous preterm delivery (SPD) between 30 and 34 weeks (SPD34) and between 34 and 37 weeks (SPD37). Methods: We performed a prospective cross-sectional study. CL was measured once by transvaginal ultrasound examination between 24 and 30 weeks. Results: The study sample consisted of 1,180 low-risk singleton pregnancies. 10 women (0.85%) had a SPD34 and 60 (5.08%) had a SPD37. CL was shorter (p < 0.001) in the women who had a SPD34 (median 11 mm) compared to the women who delivered after 34 weeks (median 31 mm). CL was shorter (p < 0.001) in the women who had a SPD37 (median 22 mm) compared to the women who delivered after 37 weeks (median 31 mm). CL predicted SPD34 (OR = 0.837, R2 = 0.2768, AUC = 0.9406, p < 0.001) and SPD37 (OR = 0.907, R2 = 0.1085, AUC = 0.7584, p < 0.001). The model achieved a sensitivity of 70.0 and 38.3% for 10% false-positive rate for SPD34 and SPD37, respectively. Conclusions: CL after 24 weeks is significantly shorter in women destined to have a SPD. In low-risk singleton pregnancies CL performs very well in predicting SPD34 and adequately in predicting SPD37.

The Length of the Cervix and the Risk of Spontaneous Preterm Delivery

2021 ◽  
pp. 32-37
Author(s):  
Julie Stone ◽  
Michael House
Keyword(s):  
Preterm Birth ◽  
Inverse Relationship ◽  
Clinical Case ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Central Component ◽  
Current Clinical Practice ◽  
Short Cervix ◽  
Spontaneous Preterm Delivery ◽  
Increased Risk

Measurement of the cervical length has become a central component of prenatal care. Mid-trimester cervical shortening is associated with preterm birth. This article summarizes a key study that established a strong correlation between cervical shortening and an increased risk of preterm birth. Transvaginal ultrasound was used to measure cervical length at 22 to 24 weeks’ gestation. The study showed that a short cervix was associated with an increased risk of preterm birth before 35 weeks. In addition, the shortest cervix conferred the highest risk, suggesting an inverse relationship. This article concludes by summarizing how cervical length is incorporated into current clinical practice. Also, a clinical case is presented.

Comparison of a novel test for placental alpha microglobulin-1 with fetal fibronectin and cervical length measurement for the prediction of imminent spontaneous preterm delivery in patients with threatened preterm labor

2015 ◽  
Vol 43 (4) ◽  
Author(s):  
Tanja Nikolova ◽  
Oleg Bayev ◽  
Natasha Nikolova ◽  
Gian Carlo Di Renzo
Keyword(s):  
Preterm Delivery ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Fetal Fibronectin ◽  
Spontaneous Preterm Delivery ◽  
Bedside Test ◽  
Study Population ◽  
Threatened Preterm Labor ◽  
Singleton Pregnancies ◽  
Spontaneous Delivery

AbstractPartoSure is a bedside test for the prediction of time-to-spontaneous preterm delivery by the detection of placental alpha microglobulin-1 (PAMG-1). The objectives of this study were to further determine the test’s efficacy in predicting delivery within 7 or 14 days from testing, and to compare it with fetal fibronectin (fFN) and cervical length (CL) measurement by transvaginal ultrasound.The study population consisted of 203 consecutively recruited women with singleton pregnancies between 20The sensitivities for PartoSure (n=203), fFN (n=66), and CL (n=203) for predicting imminent spontaneous preterm delivery within 7 days were 80%, 50%, and 57%, respectively. The specificities were 95%, 72%, and 73% for PartoSure, fFN and CL, respectively. The NPVs were 96%, 87%, and 89% for PartoSure, fFN and CL, respectively. The PPVs were 76%, 29%, and 30% for PartoSure, fFN and CL, respectively.PAMG-1 detection by PartoSure is the single best predictor of imminent spontaneous delivery within 7 days compared to fFN and CL. In settings where CL is used as an initial screen, PartoSure has the greatest clinical utility in patients with CL between 15 and 35 mm. In situations where CL is not an initial screen, PartoSure is the most accurate test compared to fFN and CL.

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