{
    "abstract": "TVS (Transvaginal Sonography) guided Cervical strain elastography (CSE) is now available in tertiary referral centers of LMICs (Low- and Middle-Income Countries). TVS cervical length (CL) assessment is being used routinely. Still, elastography is not used in clinical settings, although enough evidence suggests good predictive value towards sPTD (spontaneous Preterm Delivery). The clinical utility of elastography has not been tested among high-risk populations of LMICs for the prediction of sPTD.\nTo test the performance of TVS-CSE in predicting sPTD among asymptomatic women in the mid-trimester at risk of sPTD either due to clinical factors or due to a short cervix.\nProspective observational study performed at a tertiary hospital in South India. Asymptomatic pregnant women between 16 and 24\u2009weeks who had one or more clinical risk factors for sPTD or CL <2.5\u2009cm were included. GE Voluson E-8 ultrasound machine was used. After CL measurement, elastography color coding was noted around the internal-os in the sagittal view. The strain ratio (SR) was calculated using the trace method on three ROIs (Region of Interest): Internal-os in sagittal view (IN), whole cervix in sagittal view (WN), and internal-os in axial view (AN). Reference Tissue (RT) of similar size and depth was chosen in the darkest blue region on elastography (stiffest area) outside the cervix, posterior/lateral to the cervix over the ligament insertion. Lower the SR - softer the cervix. Two trained fetal medicine consultants performed the initial 57 cases until intra/inter-observer correlation was satisfactory. Delivery before 37\u2009weeks (after 26\u2009weeks), in which the process of labor has begun spontaneously, or labor was induced after PPROM-was considered as sPTD. SRs were assessed to determine how well they could predict sPTD independently or combined with cervical length.\nOut of 221 recruited,17 were lost to follow-up after 32\u2009weeks; 204 were delivered in our hospital. Irrespective of the route of delivery, 71 (34.8%) had sPTD. Of the remaining 133, 106 delivered at term, and 27 underwent medically indicated PTD. Apart from multiple pregnancies, no other preterm-related risk factors (including CL < 2.5\u2009cm) showed significant association with sPTD. Red CSE pattern around internal-os was associated with a significantly higher (54.5%) incidence of sPTD. CLs were similar (3.63\u2009\u00b1\u20090.67 vs. 3.63\u2009\u00b1\u20090.80, \nTVS CSE performed better than CL as an independent predictive tool toward sPTD, although predictive efficacy was modest at best. Since technology is now available in high-end USG machines in tertiary care centers, we propose optimal utilization of CSE in LMICs to triage at-risk populations since low SRs are strongly associated with sPTD.",
    "authors": [
        {
            "affiliation": "Division of Fetal Medicine, Department of Obstetrics and Gynaecology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Akhila",
            "initials": "A",
            "lastname": "Vasudeva"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Haritha",
            "initials": "H",
            "lastname": "Kodavati"
        },
        {
            "affiliation": "Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Jyothi",
            "initials": "J",
            "lastname": "Samanth"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Roopa",
            "initials": "R",
            "lastname": "Padavagodu Shivananda"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Sanghamitra",
            "initials": "S",
            "lastname": "Paladugu"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Mridula",
            "initials": "M",
            "lastname": "Raghav"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Gagana",
            "initials": "G",
            "lastname": "Hanumaiah"
        },
        {
            "affiliation": "Department of Critical Care Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Souvik",
            "initials": "S",
            "lastname": "Chaudhuri"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Nivedita",
            "initials": "N",
            "lastname": "Hegde"
        },
        {
            "affiliation": "Department of Reproductive Medicine and Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Prashanth",
            "initials": "P",
            "lastname": "Adiga"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Shripad",
            "initials": "S",
            "lastname": "Hebbar"
        },
        {
            "affiliation": "Department of Reproductive Medicine and Surgery, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.",
            "firstname": "Pratap",
            "initials": "P",
            "lastname": "Kumar"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1080/14767058.2024.2381589",
    "journal": "The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians",
    "keywords": [
        "Cervical length",
        "cervical strain elastography",
        "high-risk pregnant women",
        "spontaneous preterm delivery"
    ],
    "methods": "Prospective observational study performed at a tertiary hospital in South India. Asymptomatic pregnant women between 16 and 24\u2009weeks who had one or more clinical risk factors for sPTD or CL <2.5\u2009cm were included. GE Voluson E-8 ultrasound machine was used. After CL measurement, elastography color coding was noted around the internal-os in the sagittal view. The strain ratio (SR) was calculated using the trace method on three ROIs (Region of Interest): Internal-os in sagittal view (IN), whole cervix in sagittal view (WN), and internal-os in axial view (AN). Reference Tissue (RT) of similar size and depth was chosen in the darkest blue region on elastography (stiffest area) outside the cervix, posterior/lateral to the cervix over the ligament insertion. Lower the SR - softer the cervix. Two trained fetal medicine consultants performed the initial 57 cases until intra/inter-observer correlation was satisfactory. Delivery before 37\u2009weeks (after 26\u2009weeks), in which the process of labor has begun spontaneously, or labor was induced after PPROM-was considered as sPTD. SRs were assessed to determine how well they could predict sPTD independently or combined with cervical length.",
    "publication_date": "2024-07-26",
    "pubmed_id": "39054066",
    "results": "Out of 221 recruited,17 were lost to follow-up after 32\u2009weeks; 204 were delivered in our hospital. Irrespective of the route of delivery, 71 (34.8%) had sPTD. Of the remaining 133, 106 delivered at term, and 27 underwent medically indicated PTD. Apart from multiple pregnancies, no other preterm-related risk factors (including CL < 2.5\u2009cm) showed significant association with sPTD. Red CSE pattern around internal-os was associated with a significantly higher (54.5%) incidence of sPTD. CLs were similar (3.63\u2009\u00b1\u20090.67 vs. 3.63\u2009\u00b1\u20090.80, ",
    "title": "TVS-guided cervical strain elastography is more effective than measuring cervical length as an independent predictor of spontaneous preterm delivery in asymptomatic, high-risk women during the mid-trimester.",
    "xml": "<Element 'PubmedArticle' at 0x788504c12e30>"
}