1. SONOELASTOGRAPHY OF THE
UTERINE CERVIX AS A NEW
DIAGNOSTIC TOOL OF CERVICAL
ASSESSMENT IN PREGNANT WOMEN.

2. SONOELASTOGRAPHY IN PREDICTING
PRETERM DELIVERY IN ASYMPTOMATIC,
LOW-RISK WOMEN

3.  Despite the efforts to decrease the rate of
preterm birth, preterm delivery is still the
main cause of neonatal morbidity and
mortality responsible for 75% of all
neonatal deaths (Goldenberg RL et al, 2008) .
 Identifying patients threatened with
preterm delivery remains one of the main
obstetric challenges , the WHO estimated
that 11.1% of all births were
preterm (Blencowe H et al, 2012).

4.  Elastography is an ultrasound-based
imaging technique visualizing the stiffness
of examined region. The technique is
based on the phenomenon, that after
applying pressure with the probe, soft
tissues are compressed in a greater extent
than hard tissues and the gradient values
of strain are visualized on a color map.

5.  An increasing number of reports shows the
possible applications of elastography in
obstetrics and gynecology, for instance in
predicting the success of induction of labour
and differential diagnosis of endometrial
pathologies (Preis K et al. 2010), (Swiatkowska-Freund M
et al. 2011), (Preis K et al. 2011).
 Hernandez-Andrade et al.(2013) reported a
continuous reduction in cervical stiffness with
decreasing cervical length and increasing
gestational age, which manifested mainly in the
internal cervical os. It has also been suggested, that
elastography may hold potential to predict risk of
preterm birth (Khalil MR et al.,2013)

6.  In a study conducted by Slawomir
Wozniak. Et al published in July 2014, 333
low-risk, asymptomatic women presenting
for the routine second trimester ultrasound
scan according to the Polish
Gynecological Society recommendation
between 18-22 weeks of pregnancy.
 Elastographic assessment of the internal
os was performed using a color map: red
(soft), yellow (medium soft), blue (medium
hard) and purple (hard)

7. Elastographic (left) and ultrasound (right) images of the internal
cervical os (circles) at 18-22 weeks of pregnancy. Internal cervical
os stiffness was assessed as: A) soft (red); B) medium soft
(yellow); C) medium hard (blue); D) hard (purple).
BMC Pregnancy Childbirth. 2014; 14: 238

8.  The number of preterm deliveries (<37 weeks of
pregnancy) was significantly higher in the red and
yellow groups, than in the blue and purple groups.
The sensivity, specifity, NPV and PPV for both red
and yellow internal os assessment in predicting
preterm delivery were 85.7%, 97.6%, 98.3% and
81.1% respectively.
 Accordingly the study concluded the following:
 1. Elastographic assessment of the internal
cervical os at 18-22 weeks of pregnancy may
identify patients with high risk of preterm delivery
in the low-risk, asymptomatic population.
 2. Elastographic abnormalities may precede
ultrasound and clinical findings, such as cervical
shortening and funneling.

9. QUANTITATIVE SONOELASTOGRAPHY OF
THE UTERINE CERVIX PRIOR TO
INDUCTION OF LABOR AS A PREDICTOR
OF CERVICAL DILATION TIME.

10.  In another study performed by Hee L et
al.(2014) A total of 49 term-pregnant women
were included before induction of labor. The
approximate Young's modulus of the anterior
cervical lip was determined by the use of a
reference cap applied on the end of the
transvaginal transducer during
sonoelastography, compared to Bishop
scoring and cervical length measurements to
predict prolonged duration of cervical dilation
time (>330 min)

11.  The following results were shown
 Accordingly the study concluded that The
approximate Young's modulus is superior to the
Bishop score and the cervical length
measurements concerning the prediction of
cervical dilation time and the risk of prolonged
dilation time after induction of labor
Sensitivity Specificty
Approximate
Young’s Modulus
of Semi
quantitative
Sonoelastograpgy
74% 69%
Bishop Scoring 53% 46%
Cervical length
measurments
66% 54%

12.  Cervical strain calculation performed in: a) endocervical canal in a
sagittal plane, b) endocervical canal in a cross sectional plane at the
level of the internal os, c) endocervical canal in a cross sectional
plane at the level of the external cervical os, and d) complete cervix
in a cross sectional plane at the level of the external cervical os.
NIHPA , Ultrasound Obstet Gynecol, Sep 11, 2014

13. OTHER CLINICAL APPLICATIONS OF
SONOELASTOGRAPHY IN OBSTETRICS
AND GYNECOLOGY

14.  To characterize malignant cervical lesions
in postmenopausal women (Thomas A. et al.
2007)
 To assess stiffness in uterine fibroids
compared with the surrounding
myometrium in non-pregnant women (Ami
O. et al . 2009)
 To evaluate tissue differences in the
presence of subchorionic hematomas
(Ogawa M. et al. 2012)
 Differentiation between polyps and
leiomyomas (Hobson MA. et al. 2007)

15. Thank You