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

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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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