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Associations between strain values, method of ascertainment and patient characteristics were assessed using linear mixed models to account for within\u2010subject correlation. Inter\u2010rater agreement in defining the degree of cervical stiffness was evaluated in 120 regions of interest acquired by two operators in 20 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1557 strain estimations were performed in 262 patients at 8\u201340\u2009weeks of gestation. Adjusting for other sources of variation, (1) cervical tissue strain estimates obtained in the endocervical canal were on average 33% greater than those obtained in the entire cervix; (2) measurements obtained in the cross\u2010sectional plane of the external cervical os and sagittal plane were 45% and 13% greater than those measured in the cross\u2010sectional plane of the internal cervical os, respectively; (3) mean strain rates were 14% and 5% greater among parous women with and without a history of preterm delivery compared with those of nulliparous women, respectively, and were on average 13% greater among women with a cervical length of between 25 and 30\u2009mm compared to those with a cervical length of\u2009&gt;\u200930\u2009mm; and (4) cervical tissue strain was more strongly associated with cervical length than with gestational age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Semiquantitative elastography can be employed to evaluate changes in cervical stiffness during pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.12344","type":"journal-article","created":{"date-parts":[[2012,11,14]],"date-time":"2012-11-14T11:51:36Z","timestamp":1352893896000},"page":"152-161","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":111,"title":["Evaluation of cervical stiffness during pregnancy using semiquantitative ultrasound elastography"],"prefix":"10.1002","volume":"41","author":[{"given":"E.","family":"Hernandez\u2010Andrade","sequence":"first","affiliation":[{"name":"Perinatology Research Branch NICHD\/NIH\/DHHS  Bethesda, MD and Detroit MI USA"},{"name":"Department of Obstetrics and Gynecology Wayne State University School of Medicine  Detroit MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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