Ultrasound Elastography of the Maternal Cervix in the Prediction of Spontaneous Preterm Birth: A Prospective Cohort Study
Shikhar Sinha, Ritu Misra, Neha Bagri*, Aanchal Bhayana and Harsha Shailesh Gaikwad
ABSTRACT
Background: Spontaneous preterm birth (sPTB) remains a leading cause of neonatal morbidity and mortality worldwide, with India contributing disproportionately to the global burden. Accurate prediction of women at risk is essential for timely interventions. Conventional methods, such as cervical length (CL) measurement, have limited predictive value. Ultrasound shear wave elastography (SWE) offers a quantitative assessment of cervical stiffness, potentially improving risk stratification.
Objective: To evaluate the diagnostic accuracy of transabdominal shear wave elastography of the maternal cervix in predicting spontaneous preterm birth.
Methods: A prospective observational study was conducted on 51 pregnant women with singleton gestations between 18 and 36 weeks at VMMC & Safdarjung Hospital, New Delhi. SWE and shear wave speed (SWS) values were recorded at the internal and external cervical os using a convex transducer. Participants were followed until delivery, and pregnancy outcomes were documented.
Results: Nine participants (17.64%) experienced sPTB, higher than both the global (10%) and national (13%) rates. SWS at the internal os ≤1.4 m/s demonstrated the best predictive performance, with sensitivity and negative predictive value (NPV) of 100%. At the external os, SWS ≤1.32 m/s achieved sensitivity of 88.9% and NPV of 94.7%. SWE values showed similar trends, with high sensitivity (77.8–88.9%) and excellent NPVs (>92%).
Conclusion: Transabdominal cervical SWE is a promising, non-invasive screening tool for predicting spontaneous preterm birth. Its high sensitivity and NPV suggest strong potential for clinical use, particularly in ruling out risk and guiding preventive strategies.
