Innovative use of elastography in assessing cervical biomechanics and preterm birth risk

OBJECTIVE: The objective of this study was to investigate the relationship between cervical stiffness, as assessed by elastography, and its correlation with cervical shortening and preterm birth risk across all trimesters of pregnancy. METHODOLOGY: This prospective cohort study included 90 pregnant women (30 in the first trimester, 30 in the second trimester, and 30 in the third trimester; gestational age: 4–40 weeks). Cervical stiffness was evaluated using elastography, categorizing tissue stiffness into soft, moderate, and hard. Cervical length was measured through transvaginal ultrasound. Statistical analyses included descriptive statistics, correlation analysis, logistic regression, and receiver-operating characteristic (ROC) curve analysis to assess predictive accuracy. RESULTS: Elastographic metrics demonstrated a significant correlation between cervical stiffness and cervical length ( r = −0.72; P < 0.001). A logistic regression model identified cervical stiffness as a significant predictor of preterm birth risk (odds ratio = 3.14; 95% confidence interval: 2.09–4.72). ROC analysis revealed excellent predictive accuracy (area under the curve = 0.89). Progressive cervical stiffening was observed across trimesters, with a decrease in soft tissue percentages (13.0% to 6.1%) and an increase in stiffness transitions. CONCLUSION: Cervical elastography provides a robust and noninvasive tool for assessing preterm birth risk. Its integration into clinical workflows has the potential to enhance early intervention strategies and improve maternal–fetal outcomes.