{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T06:52:58Z","timestamp":1781679178412,"version":"3.54.5"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Spontaneous preterm birth (sPTB) remains a leading cause of neonatal morbidity and mortality, and cervical length (CL) alone has limited predictive performance in asymptomatic women. Cervical strain elastography may capture biomechanical changes that precede cervical shortening. We aimed to evaluate the predictive value of mid-trimester cervical strain elastography parameters, alone and in combination with CL, for sPTB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center cohort study with prospectively collected data, 275 singleton pregnancies underwent transvaginal assessment at 18\u202f+\u202f0 to 23\u202f+\u202f6\u202fweeks of gestation. Cervical strain elastography parameters, including hardness ratio (HR), internal os strain (IOS), external os strain (EOS), and the IOS\/EOS ratio, were obtained using E-Cervix software, together with CL. The primary outcome was sPTB before 37\u202fweeks. Logistic regression, receiver operating characteristic analysis, pairwise DeLong comparisons, and decision curve analysis were performed to assess predictive performance and clinical utility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      sPTB occurred in 37 of 275 women (13.5%). Among individual predictors, IOS showed the best discrimination for sPTB (AUC 0.797, 95% CI 0.715\u20130.878), followed by the IOS\/EOS ratio (AUC 0.758, 95% CI 0.671\u20130.846). Among combined models, CL\u202f+\u202fIOS\/EOS achieved the highest overall performance (AUC 0.828, 95% CI 0.771\u20130.885), with a sensitivity of 73% and a specificity of 82% at the Youden\u2019s\n                      <jats:italic>J<\/jats:italic>\n                      optimal cut-off. Pairwise DeLong comparisons showed that CL\u202f+\u202fIOS\/EOS significantly outperformed CL alone and IOS\/EOS alone. Decision curve analysis suggested superior net benefit for the combined model across clinically relevant threshold probabilities.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Mid-trimester cervical strain elastography, particularly IOS-related metrics, provides meaningful predictive information for sPTB. Combining elastography with CL improved discrimination and may enhance mid-trimester risk stratification beyond CL alone. External validation is warranted before routine clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1863170","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:55:49Z","timestamp":1781675749000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cervical strain elastography improves mid-trimester prediction of spontaneous preterm birth beyond cervical length: a single-center cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Dongmei","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Ultrasound, Chengdu Women\u2019s and Children\u2019s Central Hospital, School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Chengdu Women\u2019s and Children\u2019s Central Hospital, School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunrong","family":"Li","sequence":"additional","affiliation":[{"name":"Center for Pediatric Cardiology, Sichuan Provincial Women\u2019s and Children\u2019s Hospital, Affiliated Women\u2019s and Children\u2019s Hospital of Chengdu Medical College","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyue","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Statistics, Columbia University","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liuying","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Chengdu Women\u2019s and Children\u2019s Central Hospital, School of Medicine, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tongyong","family":"Luo","sequence":"additional","affiliation":[{"name":"Center for Pediatric Cardiology, Sichuan Provincial Women\u2019s and Children\u2019s Hospital, Affiliated Women\u2019s and Children\u2019s Hospital of Chengdu Medical College","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1016\/S0140-6736(23)00878-4","article-title":"National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis","volume":"402","author":"Ohuma","year":"2023","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"100107","DOI":"10.1016\/j.crphys.2023.100107","article-title":"Bioengineering and 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measurement","volume":"71","author":"Hu","year":"2024","journal-title":"IEEE Trans Biomed Eng"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/j.ajog.2012.05.015","article-title":"Beyond cervical length: emerging technologies for assessing the pregnant cervix","volume":"207","author":"Feltovich","year":"2012","journal-title":"Am J Obstet Gynecol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1002\/jum.15149","article-title":"Evaluation of cervical elastography for prediction of spontaneous preterm birth in low-risk women: a prospective study","volume":"39","author":"Du","year":"2020","journal-title":"J Ultrasound Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1080\/14767058.2020.1716721","article-title":"Cervical elastography using E-cervix\u2122 for prediction of preterm birth in singleton pregnancies with threatened preterm labor","volume":"35","author":"Nazzaro","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e39288","DOI":"10.1097\/MD.0000000000039288","article-title":"The value of real-time shear wave elastography in spontaneous preterm birth","volume":"103","author":"Lu","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1002\/uog.27614","article-title":"Longitudinal evaluation of cervical length and shear-wave elastography in women with spontaneous preterm birth","volume":"63","author":"Nguyen-Hoang","year":"2024","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"5942","DOI":"10.1038\/s41467-024-48680-9","article-title":"Whole cervix imaging of collagen, muscle, and cellularity in term and preterm pregnancy","volume":"15","author":"Wu","year":"2024","journal-title":"Nat Commun"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1934","DOI":"10.3390\/diagnostics15151934","article-title":"Diagnostic efficacy of cervical elastography in predicting spontaneous preterm birth in pregnancies with threatened preterm labor","volume":"15","author":"Kwon","year":"2025","journal-title":"Diagnostics"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1109\/TUFFC.2024.3366540","article-title":"Three-dimensional shear wave elastography using acoustic radiation force and a 2-D row-column addressing (RCA) array","volume":"71","author":"Dong","year":"2024","journal-title":"IEEE Trans Ultrason Ferroelectr Freq Control"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/s00281-020-00807-y","article-title":"Pathogenesis of preterm birth: bidirectional inflammation in mother and fetus","volume":"42","author":"Green","year":"2020","journal-title":"Semin Immunopathol"}],"container-title":["Frontiers in 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