Download PDF
Ultrasound Int Open 2016; 02(03): E83-E89
DOI: 10.1055/s-0042-110317
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Cervical Sonoelastography and Cervical Length Measurement but not Cervicovaginal Interleukin-6 Are Predictors for Preterm Birth

A. Weichert
1   Department of Obstetrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
,
D. von Schöning
1   Department of Obstetrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
,
T. Fischer
2   Department of Radiology and Ultrasound Research Laboratory, Charité-Universitätsmedizin Berlin, Berlin, Germany
,
A. Thomas
3   Department of Obstetrics and Ultrasound Research Laboratory, Charité-Universitätsmedizin Berlin, Berlin, Germany
› Author Affiliations
Further Information

Publication History

received 26 June 2015
revised 21 February 2016

accepted 17 May 2016

Publication Date:
24 August 2016 (online)

   Permissions and Reprints

Abstract

Purpose:

Worldwide, preterm birth annually affects more than 15 million infants. Despite increasing knowledge of the risk factors and mechanisms associated with preterm labor, the preterm birth rate has risen in most industrialized countries. The ability to identify women at high risk for spontaneous preterm birth is crucial yet remains difficult. The aim of the present study was to assess the value of cervical length measurements in combination with sonoelastography and interleukin 6 (IL-6) concentrations in cervicovaginal secretions to identify women at risk for preterm birth.

Materials and Methods:

36 pregnant women with signs of threatened preterm birth were enrolled in our prospective cohort study. Cervical length measurement, sonoelastography, and IL-6 levels from cervicovaginal swab samples were measured.

Results:

The preterm birth rate was found to be 33.3% in our study cohort. Maternal age did not differ between the preterm and term birth groups. Measurement of the cervical length alone was found to have a sensitivity of 0.7 and a specificity of 0.8, whereas cervical sonoelastography had a sensitivity of 0.66 and a specificity of 0.82. By using a combination of both methods, the sensitivity and specificity were found to be 0.9 and 0.7, respectively. IL-6 levels were not found to differ between women with term deliveries and women with preterm births.

Conclusion:

Both, cervical sonoelastography and cervical length measurement are valuable tools in identifying women with threatened preterm birth. The highest correlation with the outcome preterm birth was achieved using a combination of both cervical length measurement and cervical sonoelastography.

Key words

sonoelastography - cervical length - preterm birth - cervix
 

  • References

  • 1 McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 1985; 312: 82-90
    CrossrefPubMedGoogle Scholar
  • 2 Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008; 371: 261-269
    CrossrefPubMedGoogle Scholar
  • 3 Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth 2010; 10 (Suppl. 01) S1
    CrossrefPubMedGoogle Scholar
  • 4 Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller A-B, Narwal R et al. 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. The Lancet 2012; 379: 2162-2172
    CrossrefPubMedGoogle Scholar
  • 5 McClamrock HD, Jones Jr HW, Adashi EY. Ovarian stimulation and intrauterine insemination at the quarter centennial: implications for the multiple births epidemic. Fertil Steril. 2012; 97: 802-809
    CrossrefPubMedGoogle Scholar
  • 6 King JF, Grant A, Keirse MJ, Chalmers I. Beta-mimetics in preterm labour: an overview of the randomized controlled trials. Br J Obstet Gynaecol. 1988; 95: 211-222
    CrossrefPubMedGoogle Scholar
  • 7 To MS, Fonseca EB, Molina FS, Cacho AM, Nicolaides KH. Maternal characteristics and cervical length in the prediction of spontaneous early preterm delivery in twins. Am J Obstet Gynecol 2006; 194: 1360-1365
    CrossrefPubMedGoogle Scholar
  • 8 Feinberg RF, Kliman HJ, Lockwood CJ. Is oncofetal fibronectin a trophoblast glue for human implantation?. Am J Pathol 1991; 138: 537-543
    PubMedGoogle Scholar
  • 9 Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med 2000; 342: 1500-1507
    CrossrefPubMedGoogle Scholar
  • 10 Akira S, Taga T, Kishimoto T. Interleukin-6 in biology and medicine. Adv Immunol 1993; 54: 1-78
    PubMedGoogle Scholar
  • 11 Menon R, Torloni MR, Voltolini C, Torricelli M, Merialdi M, Betran AP et al. Biomarkers of spontaneous preterm birth: an overview of the literature in the last four decades. Reprod Sci 2011; 18: 1046-1070
    CrossrefPubMedGoogle Scholar
  • 12 Vousden N, Chandiramani M, Seed P, Shennan A. Interleukin-6 bedside testing in women at high risk of preterm birth. J Matern Fetal Neonatal Med 2011; 24: 1301-1304
    CrossrefPubMedGoogle Scholar
  • 13 Chong Y, Shin JH, Ko ES, Han BK. Ultrasonographic elastography of thyroid nodules: is adding strain ratio to colour mapping better?. Clin Radiol 2013; 68: 1241-1246
    CrossrefPubMedGoogle Scholar
  • 14 Ferraioli G, Parekh P, Levitov AB, Filice C. Shear wave elastography for evaluation of liver fibrosis. J Ultrasound Med 2014; 33: 197-203
    CrossrefPubMedGoogle Scholar
  • 15 Thomas A, Kummel S, Gemeinhardt O, Fischer T. Real-time sonoelastography of the cervix: tissue elasticity of the normal and abnormal cervix. Acad Radiol 2007; 14: 193-200
    CrossrefPubMedGoogle Scholar
  • 16 Swiatkowska-Freund M, Preis K. Elastography of the uterine cervix: implications for success of induction of labor. Ultrasound Obstet Gynecol 2011; 38: 52-56
    PubMedGoogle Scholar
  • 17 Molina FS, Gomez LF, Florido J, Padilla MC, Nicolaides KH. Quantification of cervical elastography: a reproducibility study. Ultrasound Obstet Gynecol 2012; 39: 685-689
    CrossrefPubMedGoogle Scholar
  • 18 von Schoning D, Fischer T, von Tucher E, Slowinski T, Weichert A, Henrich W et al. Cervical sonoelastography for improving prediction of preterm birth compared with cervical length measurement and fetal fibronectin test. J Perinat Med 2015; 43: 531-536
    PubMedGoogle Scholar
  • 19 Burger M, Weber-Rossler T, Willmann M. Measurement of the pregnant cervix by transvaginal sonography: an interobserver study and new standards to improve the interobserver variability. Ultrasound Obstet Gynecol 1997; 9: 188-193
    CrossrefPubMedGoogle Scholar
  • 20 Iams JD. Cervical ultrasonography. Ultrasound Obstet Gynecol 1997; 10: 156-160
    CrossrefPubMedGoogle Scholar
  • 21 Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health 2013; 10 (Suppl. 01) S2
    CrossrefPubMedGoogle Scholar
  • 22 Kerr-Wilson CO, Mackay DF, Smith GC, Pell JP. Meta-analysis of the association between preterm delivery and intelligence. J Public Health (Oxf) 2012; 34: 209-216
    CrossrefPubMedGoogle Scholar
  • 23 Lockwood CJ, Dudenhausen JW. New approaches to the prediction of preterm delivery. J Perinat Med 1993; 21: 441-452
    CrossrefPubMedGoogle Scholar
  • 24 Han Z, Mulla S, Beyene J, Liao G, McDonald SD. Knowledge Synthesis G . Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol 2011; 40: 65-101
    CrossrefPubMedGoogle Scholar
  • 25 McDonald SD, Han Z, Mulla S, Beyene J. Knowledge Synthesis G . Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ 2010; 341: c3428
    CrossrefPubMedGoogle Scholar
  • 26 Chang HH, Larson J, Blencowe H, Spong CY, Howson CP, Cairns-Smith S et al. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet 2013; 381: 223-234
    CrossrefPubMedGoogle Scholar
  • 27 Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A et al. 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. N Engl J Med 1996; 334: 567-572
    CrossrefPubMedGoogle Scholar
  • 28 Berghella V, Baxter JK, Hendrix NW. Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Database Syst Rev 2013; 1: CD007235
    PubMedGoogle Scholar
  • 29 van Baaren GJ, Vis JY, Wilms FF, Oudijk MA, Kwee A, Porath MM et al. Predictive value of cervical length measurement and fibronectin testing in threatened preterm labor. Obstet Gynecol 2014; 123: 1185-1192
    CrossrefPubMedGoogle Scholar
  • 30 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371: 75-84
    CrossrefPubMedGoogle Scholar
  • 31 Hadzi-Lega M, Markova AD, Stefanovic M, Tanturovski M. Correlation of cervical length, fetal fibronectin, phIGFBP-1, and cytokines in spontaneous preterm birth up to 14 days from sampling. J Perinat Med 2014;
    PubMedGoogle Scholar
  • 32 Chandiramani M, Seed PT, Orsi NM, Ekbote UV, Bennett PR, Shennan AH et al. Limited relationship between cervico-vaginal fluid cytokine profiles and cervical shortening in women at high risk of spontaneous preterm birth. PLoS One 2012; 7: e52412
    CrossrefPubMedGoogle Scholar
  • 33 Hee L, Rasmussen CK, Schlutter JM, Sandager P, Uldbjerg N. Quantitative sonoelastography of the uterine cervix prior to induction of labor as a predictor of cervical dilation time. Acta Obstet Gynecol Scand 2014; 93: 684-690
    CrossrefPubMedGoogle Scholar
  • 34 Pereira S, Frick AP, Poon LC, Zamprakou A, Nicolaides KH. Successful induction of labor: prediction by preinduction cervical length, angle of progression and cervical elastography. Ultrasound Obstet Gynecol 2014; 44: 468-475
    CrossrefPubMedGoogle Scholar
  • 35 Davidoff MJ, Dias T, Damus K, Russell R, Bettegowda VR, Dolan S et al. Changes in the gestational age distribution among U.S. singleton births: impact on rates of late preterm birth, 1992 to 2002. Semin Perinatol 2006; 30: 8-15
    CrossrefPubMedGoogle Scholar