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Cervical Elastography as a Predictive Tool for Preterm Birth: A Systematic Review and Meta-analysis.
Evgenia Angelopoulou1, Kleanthi Gourounti1, Angeliki Bolou1
1Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, GRC.
Cureus
|October 20, 2025
Summary
Cervical elastography, using strain elastography (SE) and shear wave elastography (SWE), shows moderate to good accuracy in predicting spontaneous preterm birth. These ultrasound techniques may offer complementary roles based on gestational age for improved risk assessment.
Area of Science:
- Obstetrics and Gynecology
- Medical Imaging
- Maternal-Fetal Medicine
Background:
- Spontaneous preterm birth (sPTB) is a leading cause of neonatal morbidity and mortality.
- Conventional sonographic measurements have limitations in early sPTB prediction.
- Cervical elastography is an emerging ultrasound technique assessing cervical stiffness.
Purpose of the Study:
- To evaluate the diagnostic accuracy of cervical elastography (SE and SWE) for predicting sPTB.
- To compare the performance of SE and SWE in sPTB prediction.
- To determine the optimal application timing for cervical elastography in pregnancy.
Main Methods:
- Systematic review and meta-analysis of studies published between January 2014 and March 2025.
- Inclusion of 13 studies with 4,087 pregnant women assessing SE or SWE for sPTB prediction.
- Calculation of pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) using a random-effects model.
Main Results:
- Pooled sensitivity was 77.1%, specificity 73.3%, and AUC 0.82.
- Pooled DOR was 11.05, indicating moderate to good diagnostic accuracy.
- SWE showed higher sensitivity in later gestation; SE performed better in early to mid-trimester assessments.
Conclusions:
- Cervical elastography demonstrates moderate to good diagnostic accuracy for predicting sPTB.
- SE and SWE may have complementary roles depending on gestational age.
- Cervical elastography shows potential for integration into preterm birth risk assessment strategies.
