{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:46:05Z","timestamp":1779194765994,"version":"3.51.4"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ultraschall Med"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Purpose\u2002To evaluate cervical elastography strain pattern as a predictive marker for spontaneous preterm delivery (SPTD).<\/jats:p><jats:p>\n          Materials and Methods\u2002In this case-control study cervical length (CL) and elastographic data (strain ratio, elastography index, strain pattern score) were acquired from 335 pregnant women (20th \u2013 34th week of gestation) by transvaginal ultrasound. Data of 50 preterm deliveries were compared with 285\u00a0normal controls. Strain ratio and elastography index were calculated by placing two regions of interest (ROIs) in parallel on the anterior cervical lip.\u200aThe strain ratio was determined by dividing the higher strain value by the lower one. The elastography index was defined as the maximum of the strain ratio curve. Elastographic images were assigned a new established strain pattern (SP) score between 0 and 2 according to the distribution of strain induced by compression.<\/jats:p><jats:p>\n          Results\u2002Elastography index, SP score and CL differed between preterm and normal pregnancies (1.61 vs. 1.27, p\u200a&lt;\u200a0.001; SP score value of \u201c2\u201d: n\u200a=\u200a31 (62\u200a%) vs. n\u200a=\u200a36 (12.6\u200a%), p\u200a&lt;\u200a0.001; CL 30.7 vs. 41.0\u200amm, p\u200a&lt;\u200a0.001; respectively). The elastography index and SP score were associated with a higher predictive potential than CL measurement alone (AUC 0.8059 (area under the curve); AUC 0.7716; AUC 0.7631; respectively). A combination of all parameters proved more predictive than any single parameter (AUC 0.8987; respectively).<\/jats:p><jats:p>\n          Conclusion\u2002Higher elastography index and SP scores were correlated with an elevated risk of SPTD and are superior to CL measurement as a predictive marker. A combination of these parameters could be used as a \u201cCervical Index\u201d for the prediction of SPTD.<\/jats:p>","DOI":"10.1055\/a-0865-1711","type":"journal-article","created":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T23:52:48Z","timestamp":1553557968000},"page":"397-403","source":"Crossref","is-referenced-by-count":17,"title":["Evaluation of Cervical Elastography Strain Pattern to Predict Preterm\u00a0Birth"],"prefix":"10.1055","volume":"41","author":[{"given":"Anna","family":"Gesthuysen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University-Hospital M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerstin","family":"Hammer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University-Hospital M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mareike","family":"M\u00f6llers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University-Hospital M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janina","family":"Braun","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University-Hospital M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathrin","family":"Oelmeier de Murcia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University-Hospital M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Karina","family":"Falkenberg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University-Hospital M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen Ann","family":"K\u00f6ster","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University-Hospital M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ute","family":"M\u00f6llmann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University-Hospital M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arrigo","family":"Fruscalzo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, St. Franziskus-Hospital Ahlen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eike","family":"Bormann","sequence":"additional","affiliation":[{"name":"Institute of Biostatistics and Clinical Research, University-Hospital M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walter","family":"Klockenbusch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University-Hospital M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralf","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University-Hospital M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2019,3,25]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1016\/S0140-6736(02)11476-0","article-title":"Preterm delivery","volume":"360","author":"M M Slattery","year":"2002","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1016\/S0140-6736(12)60820-4","article-title":"National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications","volume":"379","author":"H Blencowe","year":"2012","journal-title":"Lancet"},{"issue":"S 01","key":"ref3","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1186\/1742-4755-10-S1-S2","article-title":"Born Too Soon Preterm Birth Action Group. Born too soon: the global epidemiology of 15 million preterm births","volume":"10","author":"H Blencowe","year":"2013","journal-title":"Reprod Health"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"31","DOI":"10.2471\/BLT.08.062554","article-title":"The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity","volume":"88","author":"S Beck","year":"2010","journal-title":"Bull World Health Organ"},{"issue":"S 01","key":"ref5","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1186\/1471-2393-10-S1-S2","article-title":"Global report on preterm birth and stillbirth (2 of 7): discovery science","volume":"10","author":"M G Gravett","year":"2010","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref6","first-page":"CD007235","article-title":"Cervical assessment by ultrasound for preventing preterm delivery","volume":"1","author":"V Berghella","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1055\/s-2006-956777","article-title":"Dynamics of cervical remodeling during pregnancy and parturition: mechanisms and current concepts","volume":"25","author":"R A Word","year":"2007","journal-title":"Semin Reprod Med"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1056\/NEJM199602293340904","article-title":"The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network","volume":"334","author":"J D Iams","year":"1996","journal-title":"N Engl J Med"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1016\/j.jbiomech.2015.02.065","article-title":"The mechanical role of the cervix in pregnancy","volume":"48","author":"K M Myers","year":"2015","journal-title":"J Biomech"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1038\/jp.2014.87","article-title":"Quantitative elastography of the uterine cervix as a predictor of preterm delivery","volume":"34","author":"K Kobbing","year":"2014","journal-title":"J Perinatol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1515\/jpm-2016-0375","article-title":"Assessment of cervical elastography strain pattern and its association with preterm birth","volume":"45","author":"V Oturina","year":"2017","journal-title":"J Perinat Med"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"204","DOI":"10.17772\/gp\/1714","article-title":"Prognostic value of elastography in predicting premature delivery","volume":"85","author":"M Swiatkowska-Freund","year":"2014","journal-title":"Ginekol Pol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1515\/jpm-2014-0382","article-title":"Strain at the internal cervical os assessed with quasi-static elastography is associated with the risk of spontaneous preterm delivery at 34 weeks of gestation","volume":"43","author":"E Hernandez-Andrade","year":"2015","journal-title":"J Perinat Med"},{"key":"ref14","first-page":"387","article-title":"Quantitative cervical elastography during pregnancy: influence of setting features on strain calculation","volume":"42","author":"A Fruscalzo","year":"2015","journal-title":"J\u00a0Med Ultrason (2001)"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1002\/uog.12320","article-title":"Quantitative cervical elastography in pregnancy","volume":"40","author":"A Fruscalzo","year":"2012","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1002\/uog.12475","article-title":"Reply: To PMID 22173854","volume":"41","author":"A Fruscalzo","year":"2013","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1016\/j.jbiomech.2015.02.038","article-title":"Challenging the in-vivo assessment of biomechanical properties of the uterine cervix: A critical analysis of ultrasound based quasi-static procedures","volume":"48","author":"M M Maurer","year":"2015","journal-title":"J Biomech"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/GRF.0000000000000049","article-title":"Innovative methods of cervical assessment and potential for novel treatment","volume":"57","author":"H Feltovich","year":"2014","journal-title":"Clin Obstet Gynecol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1007\/s10396-016-0723-z","article-title":"Cervical elastography during pregnancy: a critical review of current approaches with a focus on controversies and limitations","volume":"43","author":"A Fruscalzo","year":"2016","journal-title":"J Med Ultrason (2001)"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1002\/uog.11067","article-title":"Quantification of cervical elastography: a reproducibility study","volume":"39","author":"F S Molina","year":"2012","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"204","DOI":"10.17772\/gp\/1714","article-title":"Prognostic value of elastography in predicting premature delivery","volume":"85","author":"M Swiatkowska-Freund","year":"2014","journal-title":"Ginekol Pol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1002\/uog.12344","article-title":"Evaluation of cervical stiffness during pregnancy using semiquantitative ultrasound elastography","volume":"41","author":"E Hernandez-Andrade","year":"2013","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1111\/aogs.12246","article-title":"Quantitative sonoelastography of the uterine cervix by interposition of a synthetic reference material","volume":"92","author":"L Hee","year":"2013","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1053\/j.semperi.2009.06.002","article-title":"Relationships between mechanical properties and extracellular matrix constituents of the cervical stroma during pregnancy","volume":"33","author":"M House","year":"2009","journal-title":"Semin Perinatol"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1148\/radiol.2391041676","article-title":"Breast disease: clinical application of US elastography for diagnosis","volume":"239","author":"A Itoh","year":"2006","journal-title":"Radiology"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1055\/s-0035-1553325","article-title":"Transient Elastography to Assess the Cervical Ripening during Pregnancy: A Preliminary Study","volume":"38","author":"L Peralta","year":"2017","journal-title":"Ultraschall in Med"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1002\/uog.14663","article-title":"Changes in shear wave speed pre- and post-induction of labor: a feasibility study","volume":"46","author":"L C Carlson","year":"2015","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"2789","DOI":"10.1016\/j.ultrasmedbio.2015.06.020","article-title":"Assessment of the Cervix in Pregnant Women Using Shear Wave Elastography: A Feasibility Study","volume":"41","author":"M Muller","year":"2015","journal-title":"Ultrasound Med Biol"},{"key":"ref29","first-page":"45","article-title":"Value of ultrasound elastography in the diagnosis and management of prostate carcinoma","volume":"13","author":"S M Dudea","year":"2011","journal-title":"Med Ultrason"},{"issue":"S 01","key":"ref30","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1159\/000345884","article-title":"Assessment of liver fibrosis with real-time tissue elastography in chronic viral hepatitis","volume":"84","author":"N Yada","year":"2013","journal-title":"Oncology"}],"container-title":["Ultraschall in der Medizin - European Journal of Ultrasound"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-0865-1711.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T22:38:42Z","timestamp":1596580722000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-0865-1711"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,25]]},"references-count":30,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2020,8,4]]},"published-print":{"date-parts":[[2020,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-0865-1711","relation":{},"ISSN":["0172-4614","1438-8782"],"issn-type":[{"value":"0172-4614","type":"print"},{"value":"1438-8782","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,25]]}}}