Ultrasound elastography capabilities in studying uterine cerviх state in pregnant women of high-risk group in the first trimester of pregnancy

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Abstract

Aim. To study capabilities of quantitative elastographic study to assess the elasticity of the uterine cervix in women with a fetal chromosomal abnormality in the first trimester of pregnancy.

Methods. 230 pregnant women of high-risk group at 11-13.6 weeks of pregnancy (parietal-coccygeal length 45-84 mm) were included in this study. The first group consisted of 213 women without fetal pathology. The second group included 17 women, in whose fetuses different chromosomal abnormalities were detected. In ultrasound examination of pregnant women in the I trimester of pregnancy, in addition to standard methods of examination, quantitative cervical elastography was performed.

Results. According to results of quantitative elastography in 14 (82.35%) out of 17 pregnant women (second group) one or another degree of the cervical tissue softening was found, and 3 (17.64%) pregnant women with fetal chromosomal pathology had stiff cervix (all 3 cases with Down syndrome). In the control group in 10 (4.7%) of 213 pregnant women relatively soft cervix was identified, and in 203 (95.3%) women cervical density was higher than the myometrial density. A statistically significant difference between the indices of SWE-Ratio in groups was revealed. Quantitative elastography, as a diagnostic test predicting the risk of miscarriage due to chromosomal abnormalities, has a high sensitivity (84.38%) and even higher specificity (95.26%) of negative predictive value 97.57%.

Conclusion. Quantitative elastography reveals a significant decrease in the cervical elasticity (softening) in pregnant women with fetal chromosomal abnormality in the I trimester of pregnancy, which allows us to recommend this method of ultrasound examination as an additional marker for early diagnosis of miscarriage due to fetal chromosomal abnormality.

About the authors

M G Tukhbatullin

Kazan State Medical Academy; Republican Clinical Hospital

Author for correspondence.
Email: kyanakova80@gmail.com

K V Yanakova

Kazan State Medical Academy; City Clinical Hospital №7

Email: kyanakova80@gmail.com

References

  1. Жученко Л.А., Андреева Е.Н., Воскобоева Е.Ю. и др. Реализация мероприятий Национального проекта «Пренатальная (дородовая) диагностика нарушений развития ребёнка» в Московской области. Рос. вестн. акушера-гинеколога. 2013; (4): 6-12.
  2. Никифоровский Н.К., Степанькова Е.А., Лукина Н.В. Роль современных методов пренатальной диагностики в выявлении хромосомных аномалий у плода. Охр. материнства и детства. 2009; 1 (13): 54-56.
  3. Akins M.L., Luby-Phelps K., Bank R.A., Mahendroo M. Cervical softening during pregnancy: regulated changes in collagen crosslinking and composition of matricellular proteins in the mouse. Biol. Reprod. 2011; 84: 1053-1062. http://dx.doi.org/10.1095/biolreprod.110.089599
  4. Burger M., Weber-Rossler T., Willmann M. Measurement of the pregnant cervix by transvaginal sonography: an interobserver study and new standards to improve the interobserver variability. Ultrasound Obstet. Gynecol. 1997; 9: 188-193. http://dx.doi.org/10.1046/j.1469-0705.1997.09030188.x
  5. Celik E., To M., Gajewska K. et al. Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment. Ultrasound Obstet. Gynecol. 2008; 31: 549-554. http://dx.doi.org/10.1002/uog.5333
  6. C´espedes I., Ophir J., Ponnekanti H., Maklad N. Elastography: elasticity imaging using ultrasound with application to muscle and breast in vivo. Ultrason. Imaging. 1993; 15: 73-88. http://dx.doi.org/10.1177/016173469301500201
  7. Garra B.S. Elastography: current status, future prospects, and making it work for you. Ultrasound Q. 2011; 27: 177-186. http://dx.doi.org/10.1097/RUQ.0b013e31822a2138
  8. Gomez R., Galasso M., Romero R. et al. Ultrasonographic examination of the uterine cervix is better than cervical digital examination as a predictor of the likelihood of premature delivery in patients with preterm labor and intact membranes. Am. J. Obstet. Gynecol. 1994; 171: 956-964. http://dx.doi.org/10.1016/0002-9378(94)90014-0
  9. Greenleaf J.F., Fatemi M., Insana M. Selected methods for imaging elastic properties of biological tissues. Annu. Rev. Biomed. Eng. 2003; 5: 57-78. http://dx.doi.org/10.1146/annurev.bioeng.5.040202.121623
  10. Hernandez-Andrade E., Hassan S.S., Ahn H. et al. Evaluation of cervical stiffness during pregnancy using semiquantitative ultrasound elastography. Ultrasound Obstet. Gynecol. 2013; 41: 152-161. http://dx.doi.org/10.1002/uog.12344
  11. Iams J.D. Cervical ultrasonography. Ultrasound Obstet. Gynecol. 1997; 10: 156-160. http://dx.doi.org/10.1046/j.1469-0705.1997.10030156.x
  12. Molina F.S., Gómez L.F., Florido J. et al. Quantification of cervical elastography: a reproducibility study. Ultrasound Obstet. Gynecol. 2012; 39: 685-689. http://dx.doi.org/10.1002/uog.11067
  13. Myers K., Socrate S., Tzeranis D., House M. Changes in the biochemical constituents and morphologic appearance of the human cervical stroma during pregnancy. Eur. J. Obstet. Gynecol. Reprod. Biol. 2009; 144 (1): S82-S89. http://dx.doi.org/10.1016/j.ejogrb.2009.02.008
  14. Preis K., Swiatkowska-Freund M., Pankrac Z. Elastography in the examination of the uterine cervix before labor induction. Ginekol. Pol. 2010; 81: 757-761.
  15. Souka A.P., Papastefanou I., Michalitsi V. et al. A predictive model of short cervix at 20-24 weeks using first-trimester cervical length measurement and maternal history. Prenat. Diagn. 2011; 31: 202-206. http://dx.doi.org/10.1002/pd.2683

© 2016 Tukhbatullin M.G., Yanakova K.V.

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