CELASTO (Cervical ELASTOgraphy) pilot study - the use of cervical elastography during pregnancy

BACKGROUND: Ultrasound assessment of cervical length is an integral part of a comprehensive examination during pregnancy, but it does not provide a complete picture of structural changes in the cervix. The use of E-Cervix elastography is a promising method to assess cervical remodeling throughout the gestation period. AIM: The aim of this study was to evaluate the possibility of using automated cervical elastography in clinical practice to analyze the main parameters of cervical elasticity and hardness in pregnancy. MATERIALS AND METHODS: This prospective pilot study included 136 patients with singleton pregnancies at gestational ages ranging from 7 to 41 weeks. Cervical elastography was performed using E-Cervix software of the W10 diagnostic ultrasound system (Samsung Medison Co., Ltd., South Korea) with evaluation of quantitative parameters such as hardness ratio, elasticity contrast index, internal os, external os. RESULTS: Correlation analysis showed that hardness ratio decreased with increasing gestational age (ρ = −0.439) and decreasing cervical length (ρ = 0.408; p < 0.001). In the group of patients with cervical length less than 25 mm, there was a decrease in hardness ratio compared to the control group (48.0 vs. 63.8%, respectively; p < 0.001). The elasticity contrast index score, which reflects cervical tissue heterogeneity, increased with gestational age and cervical shortening (ρ = 0.368 and −0.450, respectively), the parameter being higher in patients with cervical length less than 25 mm [4.73 (IQR 4.21-5.90); p < 0.001]. The increase in internal os and external os with gestational age (ρ = 0.433 and ρ = 0.365, respectively; p < 0.001) indicates softening of the cervix and is accompanied by its shortening. CONCLUSIONS: Results indicate decreased hardness and increased elasticity of the cervix with increasing gestational age and decreased cervical length. E-Cervix technology allows for assessing structural changes in the cervix throughout pregnancy, starting from early gestation.