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Published August 2020 | public
Journal Article

Evolving cervical imaging technologies to predict preterm birth


Preterm birth, defined as delivery at less than 37 weeks' gestation, increases maternal-fetal morbidity and mortality and places heavy financial and emotional burdens on families and society. Although premature cervical remodeling is a major factor in many preterm deliveries, how and why this occurs is poorly understood. This review describes existing and emerging imaging techniques and their advantages and disadvantages in assessing cervical remodeling. Brightness mode (B-mode) ultrasound is used to measure the cervical length, currently the gold standard for determining risk of preterm birth. Several new B-mode ultrasound techniques are being developed, including measuring attenuation, cervical gland area, and the cervical consistency index. Shear wave speed can differentiate between soft (ripe) and firm (unripe) cervices by measuring the speed of ultrasound through a tissue. Elastography provides qualitative information regarding cervical stiffness by compressing the tissue with the ultrasound probe. Raman spectroscopy uses a fiber optic probe to assess the biochemical composition of the cervix throughout pregnancy. Second harmonic generation microscopy uses light to quantify changes in collagen fiber structure and size during cervical maturation. Finally, photoacoustic endoscopy records light-induced sound to determine optical characteristics of cervical tissue. In the long term, a combination of several imaging approaches, combined with consideration of clinical epidemiologic characteristics, will likely be required to accurately predict preterm birth.

Additional Information

© 2020 Springer Nature Switzerland AG. Received 03 March 2020; Accepted 18 May 2020; Published 10 June 2020. The authors thank Megan Steiner, RN, for her help obtaining ultrasound images. The authors would also like to thank Debbie Frank for her assistance with editing this article. The authors are supported, in part, by a Research Grant from March of Dimes and by the Washington University School of Medicine Department of Obstetrics and Gynecology Division of Clinical Research. Author Contributions: SP, NEH, and SKE conceived the presented information. SP took the lead in writing the manuscript with input from all the authors. SP obtained original ultrasound images. All authors provided critical feedback and helped shape the manuscript. The authors declare that they have no conflict of interest. Ethics approval: N/A. Consent to participate: N/A. Authors have obtained permission to reprint relevant figures from the original authors and the publishers.

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August 22, 2023
October 20, 2023