EP18.02: The association between elastogram of the cervix and preterm delivery among parturients at risk for preterm delivery: a prospective study

Abstract

Despite efforts to reduce preterm delivery, it is still the primary cause of perinatal morbidity and mortality. Elastogram is a non-invasive sonographic measurement of the elasticity of the cervical tissue. The purpose of this study was to examine the correlation of elastography of the cervix with delivery before 37 weeks (PTD). This was a prospective study of women presenting to Shaare Zedek Medical Centre, Bikur Cholim branch, from 2014-2016. Women were included with a singleton pregnancy from 24-34 wks, who were deemed at high risk for PTD based on symptoms of premature contractions or a history of previous PTD. The ultrasound examination was done using a mid-sagittal transvaginal view of the cervix, without applying pressure. Elastogram of the internal os was measured along with cervical length and presence of sludge or funnelling. Elastogram was graded according to colour intensity into high risk (level 3-4) or low risk (level 1-2). The correlation between sonographic cervical factors and PTD were calculated using Pearson chi square test, as well as a multifactorial regression analysis to exclude confounding factors. The study included 127 women. PTD occurred in 15 cases (11.8%). A statistically significant correlation was found between PTD with elastogram of the cervix and funnelling. Women in the high risk group had a PTD risk of 3.2x (23% vs 7%, p=0.037). Women with cervical funnelling delivered early in 55% of cases versus 9.7% (p=0.003). In women at high risk for PTD, positive elastogram of the internal os of the cervix (level 3-4) was found to correlate to birth before 37 weeks.