J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 17, Number 11, November 2025, pages 618-633

Evaluation of the Combined Use of Elastography and Cervicometry With the E-Cervix Index to Predict Second Trimester Preterm Birth Risk

Figure 3. ROC curves of cervical elastography parameters in the main group. ROC: receiver operating characteristic.

**Table 1.** Baseline Characteristics of the Studied Pregnant Women
Parameter	Main group (n = 150)	Control group (n = 100)	P-value
*P < 0.05 indicates statistical significance. Age data are presented as mean ± standard deviation with 95% CI; weight, height, and BMI as median (IQR); marital and social status as absolute numbers (percentage). No statistically significant differences were observed in comorbidities between groups. BMI: body mass index; CI: confidence interval; IQR: interquartile range; UTI: urinary tract infection.
Age (years)	30.24 ± 5.68 (29.32 - 31.16)	32.17 ± 6.00 (30.98 - 33.36)	0.011*
Weight (kg)	61.50 (55.00 - 70.00)	61.35 (55.00 - 71.75)	0.944
Height (cm)	164 (160 - 168)	163 (160 - 170)	0.664
BMI	23.1 (20.8 - 25.8)	22.2 (20.2 - 26.4)	0.782
Marital status
Married	126 (84%)	90 (90%)	0.193
Unmarried	24 (16%)	10 (10%)
Social status
Housewives	48 (68.6%)	22 (31.4%)	0.183
Civil servants	96 (56.1%)	75 (43.9%)
Students	6 (66.7%)	3 (33.3%)
Comorbidities
Smoking	8 (5.3%)	6 (6.0%)	0.812
Alcohol use	3 (2.0%)	1 (1.0%)	0.622
Diabetes mellitus	12 (8.0%)	9 (9.0%)	0.799
Chronic infections (e.g., UTIs, hepatitis)	15 (10.0%)	12 (12.0%)	0.691

Table 1. Baseline Characteristics of the Studied Pregnant Women

Parameter

Main group (n = 150)

Control group (n = 100)

P-value

*P < 0.05 indicates statistical significance. Age data are presented as mean ± standard deviation with 95% CI; weight, height, and BMI as median (IQR); marital and social status as absolute numbers (percentage). No statistically significant differences were observed in comorbidities between groups. BMI: body mass index; CI: confidence interval; IQR: interquartile range; UTI: urinary tract infection.

Age (years)

30.24 ± 5.68 (29.32 - 31.16)

32.17 ± 6.00 (30.98 - 33.36)

0.011*

Weight (kg)

61.50 (55.00 - 70.00)

61.35 (55.00 - 71.75)

0.944

Height (cm)

164 (160 - 168)

163 (160 - 170)

0.664

BMI

23.1 (20.8 - 25.8)

22.2 (20.2 - 26.4)

0.782

Marital status

Married

126 (84%)

90 (90%)

0.193

Unmarried

24 (16%)

10 (10%)

Social status

Housewives

48 (68.6%)

22 (31.4%)

0.183

Civil servants

96 (56.1%)

75 (43.9%)

Students

6 (66.7%)

3 (33.3%)

Comorbidities

Smoking

8 (5.3%)

6 (6.0%)

0.812

Alcohol use

3 (2.0%)

1 (1.0%)

0.622

Diabetes mellitus

12 (8.0%)

9 (9.0%)

0.799

Chronic infections (e.g., UTIs, hepatitis)

15 (10.0%)

12 (12.0%)

0.691

**Table 2.** Clinical, Anamnestic, and Obstetric Characteristics
Category	Indicator	Main group (n = 150)	Control group (n = 100)	P-value
*P < 0.05 indicates statistically significant difference between groups. Adjusted analyses (logistic regression) accounted for maternal age, smoking, diabetes, and infections. Significant associations remained robust after adjustment. BV: bacterial vaginosis; DEC: diagnostic evacuation curettage; OMT: organ malformation of the cervix; STIs: sexually transmitted infections.
Clinical conditions	Extragenital diseases	52 (34.7%)	45 (45.0%)	0.001*
	Threatening abortion/false contractions	73 (48.7%)	15 (15.0%)	0.001*
Gynecological history	Cervical polyp	10 (6.7%)	5 (5.0%)	0.787
	Erosion/ectropion of cervix (history)	73 (48.7%)	65 (65.0%)	0.014*
	Congenital anomaly of the cervix (OMT)	18 (12.0%)	6 (6.0%)	0.130
	Infections (BV, STIs, chorioamnionitis)	25 (16.7%)	22 (22.0%)	0.323
Obstetric status	Primigravida-primipara	56 (53.8%)	48 (46.2%)	0.190
	Multigravida-primipara	41 (61.2%)	26 (32.9%)
	Multigravida-multipara	53 (61.7%)	26 (32.9%)
Burdened obstetric history	Spontaneous miscarriage	20 (74.1%)	7 (25.9%)	0.023*
	Medical abortion	24 (64.9%)	13 (35.1%)	0.791
	Missed miscarriage	32 (21.3%)	10 (10.0%)	0.019*
	Ectopic pregnancy	29 (19.3%)	6 (6.0%)	0.003*
	Preterm birth	45 (88.2%)	6 (11.8%)	0.001*
Previous operative interventions	Curettage of uterine cavity	14 (9.3%)	8 (8.0%)	0.822
	Cesarean section/myomectomy	15 (10.0%)	7 (7.0%)	0.498
	DEC	10 (6.7%)	7 (7.0%)	1.000

Table 2. Clinical, Anamnestic, and Obstetric Characteristics

Measurement parameters	Main group (mean ± SD)	Control group (mean ± SD)
SD: standard deviation.
Cervical length, cm	2.6 ± 0.5	3.5 ± 0.4
Elasticity contrast index	6.5 ± 1.2	4.2 ± 0.9
Internal cervical os	0.37 ± 0.10	0.55 ± 0.08
External cervical os	0.32 ± 0.09	0.50 ± 0.07
Internal to external os stiffness ratio	1.15 ± 0.3	1.10 ± 0.2

Age (years)	Main group (n = 150)			Control group (n = 100)
Age (years)	n	CL, cm (Me, IQR)	ECI (Me, IQR)	n	CL, cm (Me, IQR)	ECI (Me, IQR)
CL: cervical length; ECI: elasticity contrast index; ICI: isthmic-cervical insufficiency; IQR: interquartile range; Me: median.
19 - 24	23	2.51 (2.29 - 2.92)	6.59 (6.25 - 7.10)	12	3.06 (2.37 - 3.56)	3.17 (2.01 - 3.80)
25 - 30	47	2.63 (2.33 - 3.11)	6.32 (6.20 - 6.69)	24	3.21 (2.72 - 3.90)	3.55 (2.95 - 4.28)
31 - 36	61	2.56 (2.41 - 2.93)	6.59 (6.25 - 6.93)	41	3.77 (3.28 - 4.24)	3.76 (3.25 - 4.38)
37 - 42	15	2.87 (2.58 - 3.11)	6.32 (6.20 - 6.70)	19	3.72 (3.12 - 3.99)	3.55 (2.85 - 4.36)
43 and older	4	2.73 (2.04 - 3.31)	6.22 (5.72 - 6.65)	4	3.18 (1.57 - 3.98)	3.96 (3.02 - 4.42)

Parameter	AUC	Sensitivity (%)	Specificity (%)
Elasticity contrast index showed the strongest predictive value. Other indices such as cervical length, hardness ratio, and IOS/EOS separately had poor diagnostic performance (AUC ≤ 0.58). AUC: area under the curve; CL: cervical length; EOS: external cervical os; IOS: internal cervical os.
Elasticity contrast index	0.89	87	85
Stiffness coefficient	0.85	83	82
Internal to external os stiffness ratio	0.82	79	78
Other indices (CL, hardness ratio, IOS/EOS separate)	≤ 0.58

Types	Methods of correction	Frequency (%)
ICI: isthmic-cervical insufficiency.
Single methods	Obstetric pessary	20 (8%)
	Surgical correction of ICI	60 (24%)
Combined methods	Obstetric pessary + progesterone preparations	25 (10%)
	Surgical correction of isthmic-cervical insufficiency of the cervix + obstetric pessary	16 (6.4%)
	Surgical correction of isthmic-cervical insufficiency of the cervix + progesterone preparations	21 (8.4%)
	Surgical correction of isthmic-cervical insufficiency of the cervix + obstetric pessary + progesterone preparations	8 (3.2%)

Indicators	Main group (n = 150)	Control group (n = 100)	P-value
ICI: isthmic-cervical insufficiency.
Pregnancy outcomes
Preterm birth, n (%)	24 (16%)	8 (8%)	0.047
Spontaneous labor, n (%)	102 (68%)	66 (66%)
Prolonged pregnancy, n (%)	24 (16%)	26 (26%)
Neonatal outcomes
Birth weight (kg, mean ± SD)	2.8 ± 0.6	3.2 ± 0.5	< 0.05
Apgar score at 5 min (mean ± SD)	7.5 ± 1.0	8.8 ± 0.7	< 0.05
Gestational age (weeks, mean ± SD)	37 ± 3	38 ± 2	< 0.05