Predictive value of cervical shear wave elastography combined with cervical morphological parameters for preterm...

This study aims to investigate the predictive value of shear-wave elastography (SWE) parameters, combined with cervical morphological parameters [cervical length (CL) and anterior cervical angle (ACA)] for spontaneous preterm birth (sPTB) in patients with cervical insufficiency following transvaginal cervical cerclage, thereby providing a reference for early clinical intervention.

Clinical data of 662 pregnant women diagnosed with cervical insufficiency who underwent vaginal cervical cerclage at Zhenjiang First People's Hospital between January 1, 2018, and October 31, 2024, were retrospectively collected. Participants were divided into a preterm birth group (98 cases, <37 weeks) and a full-term group (564 cases, ≥37 weeks) based on gestational age at delivery. All patients underwent transvaginal ultrasound within 24 h before cerclage and during postoperative follow-up (19-36⁺⁶ weeks gestation) to measure CL, ACA, and SWE parameters, including Young's modulus of the anterior external os (AE), anterior internal os (AI), peak Young's modulus (PI), and mean Young's modulus (PE). For predictive analysis, ultrasonographic parameters measured at 24-27⁺⁶ weeks were used. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for preterm birth. The predictive performance of individual indicators and their combination was evaluated using receiver operating characteristic (ROC) curve analysis.

CL and SWE parameters (AE, AI, PI, PE) were significantly lower in the preterm group than in the full-term group, while ACA was significantly higher (all p < 0.05). Multivariate logistic regression analysis showed that ACA > 111.55° was an independent risk factor for preterm birth after cerclage, while CL > 25.95 mm, AE > 8.845 kPa, AI > 14.01 kPa, PI > 16.47 kPa, and PE > 10.725 kPa were protective factors against preterm birth after cerclage (all p < 0.001). ROC curve analysis revealed that the combined detection model achieved an area under the curve (AUC) of 0.962, which was significantly higher than that of any single indicator (AUC range: 0.614-0.931). The sensitivity, specificity, and Youden index of the combined model were 96.7, 94.5%, and 0.912, respectively.

SWE parameters combined with cervical morphological parameters are closely associated with sPTB after cerclage in patients with cervical insufficiency. The combination of these three indicators significantly improves predictive performance, providing reliable imaging-based evidence for precise pregnancy risk assessment and individualized intervention strategies.

Cervical shear-wave elastography parameters, in combination with cervical morphological parameters (cervical length and anterior cervical angle), can effectively predict the risk of spontaneous preterm birth in patients with cervical insufficiency after cerclage. The predictive model integrating these indicators demonstrates high accuracy and provides a reliable tool for clinical assessment, supporting individualized pregnancy monitoring and intervention strategies.