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

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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.

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About the authors

Vladislava V. Khalenko

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Author for correspondence.
Email: vkhalenko@gmail.com
ORCID iD: 0000-0001-5313-2259
SPIN-code: 9694-3758

MD

Russian Federation, 3 Mendeleevskaya Line, Saint Petersburg, 199034

Ekaterina V. Kopteeva

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: ekaterina_kopteeva@bk.ru
ORCID iD: 0000-0002-9328-8909
SPIN-code: 9421-6407
Scopus Author ID: 57219285002

MD

Russian Federation, 3 Mendeleevskaya Line, Saint Petersburg, 199034

Olesya N. Bespalova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: shiggerra@mail.ru
ORCID iD: 0000-0002-6542-5953
SPIN-code: 4732-8089
Scopus Author ID: D-3880-2018

MD, Dr. Sci. (Med.)

Russian Federation, 3 Mendeleevskaya Line, Saint Petersburg, 199034

Olga V. Pachuliia

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: for.olga.kosyakova@gmail.com
ORCID iD: 0000-0003-4116-0222
SPIN-code: 1204-3160
Scopus Author ID: 57299197900

MD, Cand. Sci. (Med.)

Russian Federation, 3 Mendeleevskaya Line, Saint Petersburg, 199034

Ekaterina A. Kornyushina

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: hapacheva@yandex.ru
SPIN-code: 5844-1975

MD, Cand. Sci. (Med.)

Russian Federation, 3 Mendeleevskaya Line, Saint Petersburg, 199034

Igor Yu. Kogan

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: ikogan@mail.ru
ORCID iD: 0000-0002-7351-6900
SPIN-code: 6572-6450
Scopus Author ID: 56895765600
ResearcherId: P-4357-2017

MD, Dr. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences

Russian Federation, 3 Mendeleevskaya Line, Saint Petersburg, 199034

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. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Application of E-Cervix technology in patients with their unchanged (a) or shortened (b) cervix. The white line represents the cervical canal tracing, the internal and external os of the cervix are represented by white round sectors, a green six-dot indicator indicates the reliability of the acquired image, the E-Cervix parameter values are displayed in the lower right corner

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3. Fig. 2. Frequency distribution of all studies depending on gestational age

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4. Fig. 3. Dependence of the main elastographic parameters on gestational age: a, hardness ratio (HR); b, elasticity contrast index (ECI); c, internal os strain (IOS); d, external os strain (EOS)

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5. Fig. 4. Dependence of the main elastographic parameters on cervical length: a, hardness ratio (HR); b, elasticity contrast index (ECI); c, internal os strain (IOS); d, external os strain (EOS)

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