title: Cervical HI-RTE elastography and pregnancy outcome: a prospective study.
abstract: OBJECTIVE
  To study cervix elastography measurement and its relation with pregnancy outcome.
  
  
  METHODS
  A two year prospective longitudinal study evaluated cervical elasticity by HI-RTE (Hitachi real-time tissue elastography) imaging during three trimesters of pregnancy. The main outcome measure was elastography index the cervical elastogram color-coded.
  
  
  RESULTS
  Three hundred eighty seven measurements were realized among 72 pregnant women prospectively enrolled. In the first trimester, the elasticity index was significantly lower in women who subsequently had unfavorable outcome than in women who delivered at term (respectively, EI=0.51 (±0.04) and 0.59 (±0.02); P=0.037). The negative predictive value of posterior lip color (blue, blue-green=hard cervix) was high NPV=83.8 95% CI [68.8-92.4] in the first trimester (SE=64.7 95% CI [41.3-82.7]; SP=60.8 95% CI [47.1-72.9]; VPP=35.5 95% CI [21.1-53.1]). A first-trimester elasticity index threshold value ≤0.38 had a specificity of 98.0% and a NPV of 80.9% (Se 29.4%, PPV 83.3%). This index value, when combined with a cervical length less than or equal to 36mm, increased the risk of adverse outcome (HR 8.87 95% CI [3.22-23.7]).
  
  
  CONCLUSIONS
  Cervical elastography index is associated with unfavorable obstetrical outcomes, independently of cervical length. The study was registered in ClinicalTrials.gov under Identifier number NCT01032564.
authors: Department of Gynaecology and Obstetrics, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, AMU, Gynépole Marseille, Hôpital Nord, Chemin des Bourrely, 13915 Cedex 20 Marseille, France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095 Marseille, France.
authors: Laura
authors: L
authors: Sabiani
authors: Department of Gynaecology and Obstetrics, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, AMU, Gynépole Marseille, Hôpital Nord, Chemin des Bourrely, 13915 Cedex 20 Marseille, France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095 Marseille, France.
authors: Jean-Baptiste
authors: JB
authors: Haumonte
authors: Medical Evaluation, Department of Public Health, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, Marseille, France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095 Marseille, France.
authors: Anderson
authors: A
authors: Loundou
authors: C2MA, Ecole des Mines d'Alès, Alès, France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095 Marseille, France.
authors: Anne-Sophie
authors: AS
authors: Caro
authors: CIC 1409, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, AMU, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095 Marseille, France.
authors: Julie
authors: J
authors: Brunet
authors: Department of Gynaecology and Obstetrics, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, AMU, Gynépole Marseille, Hôpital Nord, Chemin des Bourrely, 13915 Cedex 20 Marseille, France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095 Marseille, France.
authors: Jean-Francois
authors: JF
authors: Cocallemen
authors: Department of Gynaecology and Obstetrics, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, AMU, Gynépole Marseille, Hôpital Nord, Chemin des Bourrely, 13915 Cedex 20 Marseille, France; Medical Evaluation, Department of Public Health, Assistance Publique-Hôpitaux de Marseille, AMU, Aix-Marseille Université, Marseille, France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095 Marseille, France.
authors: Claude
authors: C
authors: D'ercole
authors: Department of Gynaecology and Obstetrics, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, AMU, Gynépole Marseille, Hôpital Nord, Chemin des Bourrely, 13915 Cedex 20 Marseille, France; CIC 1409, Assistance Publique des Hôpitaux de Marseille (AP-HM), Aix Marseille Université, AMU, Hôpital de la Conception, 147 bd Baille, 13005 Marseille, France; Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UM63, CNRS 7278, IRD 198, Inserm 1095 Marseille, France. Electronic address: florence.bretelle@ap-hm.fr.
authors: Florence
authors: F
authors: Bretelle
mesh_terms: D000328:Adult; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011264:Pregnancy Trimesters; D011446:Prospective Studies; D012307:Risk Factors
keywords: Cervical length; Elastography; Preterm birth; Transvaginal ultrasound