title: Cervical stiffness evaluated in vivo by endoflip in pregnant women.
abstract: OBJECTIVE
  To determine the stiffness of the pregnant uterine cervix in vivo.
  
  
  METHODS
  Five women in early pregnancy and six women in late pregnancy were included. The EndoFlip is a 1-m-long probe with a 12-cm-long bag mounted on the tip. The tip of the probe was inserted into the cervical canal. Sensors spaced at 0.5-cm intervals along the probe were used to determine 16 serial cross-sectional areas of the bag. The diameter of the cervical canal could thereby be determined during inflation with up to 50 ml saline solution. Tissue stiffness was calculated from the geometric profiles and the pressure-strain elastic modulus (EP) at each sensor site. Three parts of the cervix were defined: the uterus-near part, the middle and the vaginal part. The EPmax was defined as the highest EP detected along the cervical canal.
  
  
  RESULTS
  The EPmax was always found in the middle part of the cervix. The median EPmax was 243 kPa (IQR, 67-422 kPa) for the early pregnant women and 5 kPa (IQR, 4-15 kPa) for those at term. In the early pregnant women the stiffness differed along the cervical length (p<0.05) whereas difference along the cervix was not found for late pregnant women. A positive correlation coefficient (Spearman's rho) was established between the EPs of the uterus-near and the middle part (0.84), between the vaginal and the middle part (0.81), and between the uterus-near and the vaginal part (0.85).
  
  
  CONCLUSIONS
  This new method can estimate the stiffness along the cervical canal in vivo. This method may be useful in the clinical examination of the biomechanical properties of the uterine cervix.
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Hee
authors.affiliation: Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Mech-Sense, Department of Gastroenterology and Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Donghua
authors.initials: D
authors.lastname: Liao
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Puk
authors.initials: P
authors.lastname: Sandager
authors.affiliation: Giome Center, College of Bioengineering, Chongqing University, Chongqing, China; Giome Institute, GIOME FZE, Ras Al Khaimah, United Arab Emirates.
authors.forename: Hans
authors.initials: H
authors.lastname: Gregersen
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Uldbjerg
mesh_terms: D001696:Biomechanical Phenomena; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000502:physiology*; D055119:Elastic Modulus; D005260:Female; D006801:Humans; D019047:Phantoms, Imaging; D011247:Pregnancy; D011312:Pressure; D015203:Reproducibility of Results; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014621:Vagina / Q000000981:diagnostic imaging / Q000502:physiology