Abstract
Quantitative measurement of cervical stiffness in the first trimester could improve detection of patients with subsequent cervical dysfunction. We hypothesize that cervical stiffness is lower in patients with cervical insufficiency. Our objective was to compare cervical stiffness in patients with cervical insufficiency and in normal controls using a novel aspiration-based device. This is a cross-sectional study of patients presenting for cerclage at a single academic center. Cervical stiffness was measured using a device placed on the cervix during a speculum exam. The device measures the aspiration pressure required to displace tissue to a predefined deformation level (Pcl). Stiff tissue requires increased Pcl, while soft tissue requires lower values. The average of three measurements were used for analysis. Cerclage patients were subdivided into two groups: history-indicated and ultrasound-indicated. The control groups included pregnant women between 12w0d and 23w6d without a history of cervical insufficiency and were gestationally age matched to the patients in the cerclage group; 1T: 12-13 weeks and 2T: 16-23 weeks. Women who already had a cerclage in place, multiple gestations, active genital infection, or prior cervical excision procedures were excluded. Data from 36 women were analyzed; 20 patients in the cerclage group (11 history-indicated and 9 ultrasound-indicated) and 16 control patients (8 in each group). The mean ± SD Pcl measurement in the history-indicated cerclage group was 108 ±26 compared to 143 ±35 for control group 1T (p = 0.03). The Pcl measurement in the ultrasound-indicated cerclage group was 73 ±39 compared to 99 ±22 for control group 2T (p = 0.12). In this pilot study, patients presenting for history-indicated cerclage had significantly lower cervical stiffness values compared to normal controls, as measured by an aspiration-based device. Quantitative measurement of cervical stiffness is a promising technique for objective measurement of cervical stiffness. Future studies will determine pregnancy outcomes as a function of cervical stiffness.
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