Authors
1
Resident of radiodiagnosis , ministry of health
2
Professor of radiodiagnosis, Faculty of medicine ,Fayoum university
3
Lecturer of radiodiagnosis, Faculty of medicine ,Fayoum university
4
Assistant professor of radiodiagnosis, Faculty of medicine ,Fayoum university
5
Professor of radiodiagnosis,Faculty of medicine , Zagazig University
Abstract
Background: Obstetricians exert a lot of efforts to decrease the rate of perinatal morbidity and mortality of mothers and their offspring. Preterm delivery is known to be one of the chief causes for this burden. The aim of this study was to estimate the potential value of elastographic evaluation of cervical canal stiffness at 12-14 weeks of pregnancy in women with cervical incompetence in the prediction of spontaneous preterm delivery. Patient and Methods: This prospective
observational study included 40 women presenting for the routine first trimester ultrasound scan between 12-14 weeks of pregnancy. Ultrasound examinations of the cervix were performed transvaginally (TV). The following data were recorded: elastographic color assessment of the cervical canal and ultrasound cervical length at 12-14 and weeks of pregnancy; maternal age; obstetrical history; gestational age at birth. Elastographic assessment of the cervical canal was
performed using a color map: Red (soft), Yellow (medium soft), Green (medium hard) and Purple (hard). If two colors were visible in the region of the cervical canal, the softer option was noted. The collected data were organized, tabulated
and statistically analyzed using SPSS software statistical computer package version 18 (SPSS Inc., USA). For quantitative data, the mean, standard deviation (SD), and range were calculated. Mann-Whitney-U test and Kruskal- Wallis test were used as a test of significance to compare between two and three groups, respectively. Qualitative data were presented as number and percentages, chi square (χ2) was used as a test of significance. Spearman correlation test was run to identify relation between cervical elasticity and cervical length. For interpretation of results of tests of significance, significance was adopted at p value ≤ 0.05. Results: The number of preterm deliveries ( <37 weeks of pregnancy) was significantly
higher in the Red and Yellow groups, than inthe Green and Purple groups. The sensitivity, specificity, NPV and PPV in predicting preterm delivery for Red color group in patients withcervix length ˂ 25 mm were 62.5%, 71.9%, 35.7% and 88.5% respectively with total accuracy of 70% . When adding the “yellow color” the sensitivity was raised to 87.5%, yet, the specificity dropped to 62.5% and the total accuracy dropped to 67.5%. Conclusion: Elastographic assessment of the
cervical canal at 12-14 weeks of pregnancy may identify patients with high risk of preterm delivery in women with cervical incompetence.
Keywords
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