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Diagnostic accuracy of strain cervical elastography as a predictor for preterm delivery: A single tertiary care
Abhinash Sharma1, Shruti Thakur1, Ashwani Tomar1
1Department of Radiodiagnosis, IGMC, Shimla, India.
Insights
Cervical elastography accurately predicts preterm delivery. Red color at the internal os, along with strain ratio and cervical length, are key indicators for timely intervention in pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Medical Imaging
- Reproductive Health
Background:
- Preterm delivery is a leading cause of neonatal mortality and morbidity globally.
- Predicting preterm birth remains a significant clinical challenge.
- Cervical elastography is an emerging imaging technique for assessing cervical tissue properties.
Purpose of the Study:
- To evaluate the diagnostic accuracy of transvaginal strain cervical elastography in predicting preterm delivery.
- To identify specific elastographic parameters indicative of preterm birth risk.
Main Methods:
- A prospective observational study involving 75 low-risk asymptomatic pregnant women.
- Transvaginal ultrasound and strain elastography were performed in the second and third trimesters.
- Cervical length, color codes, and strain ratios from multiple cervical regions were analyzed and compared with delivery outcomes.
Main Results:
- Red color (soft tissue) at the anterior lip of the internal os demonstrated high specificity (96.87%) and sensitivity (63.64%) for predicting preterm delivery.
- An elastography strain ratio >2 at the internal os and cervical length ≤2.8 cm were identified as additional predictors.
- These elastographic findings were correlated with cervical length and delivery groups (preterm vs. term).
Conclusions:
- Cervical elastography shows potential as a reliable tool for predicting preterm delivery.
- Specific elastographic features, particularly cervical tissue softness, can aid in identifying high-risk pregnancies.
- Further research may validate cervical elastography for routine clinical use in preterm birth risk assessment.
Introduction:
Preterm delivery is a grave and demanding problem that accounts for the major cause of neonatal deaths and long-term morbidities. It remains an unresolved health issue of global dimensions. Cervical elastography is evolving as a useful diagnostic tool for its timely prediction so that individualised management can be done.
Aim:
To assess the diagnostic accuracy of transvaginal strain cervical elastography in prediction of preterm delivery.
Methods:
This prospective observational study was conducted from June 2021 to August 2022 in a tertiary care institute of North India. A total of 75 low-risk asymptomatic women were included. Transvaginal ultrasound was performed for the cervical length in the second and third trimesters. In addition, we collected strain elastography data such as colour codes from six regions of the cervix, that is, at the anterior and posterior lips of internal os, middle one-third of the cervix and the external os, and the strain ratios from these three cervical levels were also calculated. Then these parameters were compared with cervical length, second and third trimester groups and also with preterm and term delivery groups.
Result:
The red colour (soft colour) at the anterior lip of internal os was the best predictor of preterm delivery in our study with a sensitivity and specificity of 63.64% and 96.87%, respectively. The elastography strain ratio of >2 at the internal os and cervical length ⩽2.8 cm were the additional predictors for the same.
Conclusion:
Cervical elastography can serve as a potential and reliable predictor for preterm delivery.
