title: Quantitative elastography of the uterine cervix as a predictor of preterm delivery.
abstract: OBJECTIVE
  To evaluate the correlation between preterm delivery before 37 weeks of gestation and ultrasound elastography strain measurement of cervical stiffness.
  
  
  METHODS
  In this prospective study, 182 pregnant women were examined vaginally by ultrasound elastography from a mid-sagittal plane. Cervical length was measured and strain was calculated in four regions of interest on the anterior cervical lip. First, the software was validated by intraobserver variability. Second, strain and strain ratios were calculated with adjusted software presets and correlated to the outcome of spontaneous preterm delivery (sPTD).
  
  
  RESULTS
  A total of 8928 regions of interest (ROIs) and 6696 ratios were evaluated. The median gestational age at examination was 26 ± 6.1 weeks. A median maternal age of 33 ± 5.6 and a medial parity of 1 ± 0.9 were observed. Intra-Class-Correlation values in validation phase ranged from 0.893 to 0.967. The prevalence of sPTD was 11.9%. Strain ratio Rselective was identified as the best predictor of preterm delivery. Rselective values >0.89 were associated with preterm delivery with a sensitivity of 0.59 and a specificity of 0.86 (odds ratio=1.474 for an increase of 0.1 in Rselective; P=0.002).
  
  
  CONCLUSIONS
  Ultrasound elastography strain measurement of cervical stiffness is correlated with the predictability of preterm delivery.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Köbbing
authors.affiliation: Department of Obstetrics and Gynecology, St Mathias-Spital, Rheine, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Fruscalzo
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Hammer
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Möllers
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Falkenberg
authors.affiliation: Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kwiecien
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Klockenbusch
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Münster, Münster, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Schmitz
mesh_terms: D000328:Adult; D054791:Cervical Length Measurement; D020070:Cervical Ripening / Q000502:physiology; D002584:Cervix Uteri / Q000000981:diagnostic imaging* / Q000502:physiology; D015331:Cohort Studies; D004548:Elasticity / Q000502:physiology; D054459:Elasticity Imaging Techniques; D005069:Evaluation Studies as Topic; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008875:Middle Aged; D007752:Obstetric Labor, Premature / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055815:Young Adult