{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:19:15Z","timestamp":1786645155808,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T00:00:00Z","timestamp":1759536000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify distinct cervical remodeling phenotypes based on ultrasound and quantitative elastography parameters using cluster analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center, prospective, observational study was conducted from February 2023 to January 2024 and included 373 pregnant women with singleton pregnancies between 6\u2009+\u20090 and 41\u2009+\u20090\u2009weeks of gestation (total number of ultrasound examinations: 516). Cervical elastography was performed using the E\u2010Cervix software (Samsung Medison, W10 system), with assessment of quantitative parameters (hardness ratio [HR], elasticity contrast index [ECI], internal os [IOS], external os [EOS]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Correlation analysis demonstrated that cervical hardness (HR) decreased, while tissue heterogeneity (ECI) and internal and external os deformation (IOS, EOS) increased with gestational age and cervical shortening. Cluster analysis identified three cervical phenotypes: the \u201cimmature cervix\u201d phenotype had the greatest cervical length (37.4\u2009mm [interquartile range 36.3\u201338.4]) and highest stiffness (HR 76.7% [75.7\u201377.7]), while the \u201cmature cervix\u201d phenotype showed the shortest length (24.1\u2009mm [22.9\u201325.4]) and lowest stiffness (HR 38.1% [36.9\u201339.3]). Bishop scores differed significantly among the clusters (4, 6, and 8, respectively). The risk of spontaneous labor within 14\u2009days was highest in the mature cervix group (HR 10.1,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Decreasing HR and increasing ECI, IOS, and EOS indicate progressive cervical softening as pregnancy advances and the cervix shortens. The combination of elastography parameters and cervical length can be used to objectively assess cervical remodeling during pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jum.70078","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T08:29:51Z","timestamp":1759566591000},"page":"419-427","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cervical Maturity Assessment Based on Ultrasound Elastography E\u2010Cervix"],"prefix":"10.1002","volume":"45","author":[{"given":"Ekaterina V.","family":"Kopteeva","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Perinatology D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine  St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5313-2259","authenticated-orcid":false,"given":"Vladislava V.","family":"Khalenko","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Perinatology D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine  St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga V.","family":"Pachuliia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Perinatology D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine  St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olesya N.","family":"Bespalova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Perinatology D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine  St. Petersburg Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,4]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.17816\/JOWD114934"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2017.07.014"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.260203"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12134492"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0301-2115(03)00336-1"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(95)91469-2"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.17816\/JOWD623593"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.5468\/ogs.2020.63.1.42"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.17772\/gp\/1714"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2022.100804"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.14170"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2020.1716721"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.05.017"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060520985338"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10010075"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.27614"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xagr.2025.100462"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-019-05377-5"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14742"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-02498-3"}],"container-title":["Journal of Ultrasound in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jum.70078","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T09:07:39Z","timestamp":1767344859000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jum.70078"}},"subtitle":["Cluster Analysis"],"short-title":[],"issued":{"date-parts":[[2025,10,4]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/jum.70078"],"URL":"https:\/\/doi.org\/10.1002\/jum.70078","archive":["Portico"],"relation":{},"ISSN":["0278-4297","1550-9613"],"issn-type":[{"value":"0278-4297","type":"print"},{"value":"1550-9613","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,4]]},"assertion":[{"value":"2025-04-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}