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

Figures

↓  Figure 1. Flowchart of patient selection and study procedures.
Figure 1.
↓  Figure 2. E-Cervix screen for cervical stiffness assessment.
Figure 2.
↓  Figure 3. ROC curves of cervical elastography parameters in the main group. ROC: receiver operating characteristic.
Figure 3.
↓  Figure 4. ROC curves for cervicometry and elastography parameter. ROC: receiver operating characteristic.
Figure 4.
↓  Figure 5. Methods of ICI correction in the main group. ICI: isthmic-cervical insufficiency.
Figure 5.

Tables

↓  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 3. Cervical Length and Elastography Parameters
 
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

 

↓  Table 4. Cervical Length and Elasticity Index by Age in Pregnant Women With and Without ICI
 
Age (years) Main group (n = 150) Control group (n = 100)
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)

 

↓  Table 5. Predictive Accuracy of Elastography Parameters
 
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

 

↓  Table 6. Methods of Correction in Pregnant Women With ICI (Main Group)
 
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%)

 

↓  Table 7. Analysis of Pregnancy Outcomes and Neonatal Results in Women With and Without ICI
 
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