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Evolving cervical imaging technologies to predict preterm birth

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Abstract

Preterm birth, defined as delivery at less than 37 weeks’ gestation, increases maternal-fetal morbidity and mortality and places heavy financial and emotional burdens on families and society. Although premature cervical remodeling is a major factor in many preterm deliveries, how and why this occurs is poorly understood. This review describes existing and emerging imaging techniques and their advantages and disadvantages in assessing cervical remodeling. Brightness mode (B-mode) ultrasound is used to measure the cervical length, currently the gold standard for determining risk of preterm birth. Several new B-mode ultrasound techniques are being developed, including measuring attenuation, cervical gland area, and the cervical consistency index. Shear wave speed can differentiate between soft (ripe) and firm (unripe) cervices by measuring the speed of ultrasound through a tissue. Elastography provides qualitative information regarding cervical stiffness by compressing the tissue with the ultrasound probe. Raman spectroscopy uses a fiber optic probe to assess the biochemical composition of the cervix throughout pregnancy. Second harmonic generation microscopy uses light to quantify changes in collagen fiber structure and size during cervical maturation. Finally, photoacoustic endoscopy records light-induced sound to determine optical characteristics of cervical tissue. In the long term, a combination of several imaging approaches, combined with consideration of clinical epidemiologic characteristics, will likely be required to accurately predict preterm birth.

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Acknowledgments

The authors thank Megan Steiner, RN, for her help obtaining ultrasound images. The authors would also like to thank Debbie Frank for her assistance with editing this article.

Funding

The authors are supported, in part, by a Research Grant from March of Dimes and by the Washington University School of Medicine Department of Obstetrics and Gynecology Division of Clinical Research.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA

    Stephanie Pizzella, Nicole El Helou, Jessica Chubiz, Sarah K. England & Molly J. Stout

  2. Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA

    Lihong V. Wang

  3. Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA

    Methodius G. Tuuli

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  1. Stephanie Pizzella
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Contributions

SP, NEH, and SKE conceived the presented information. SP took the lead in writing the manuscript with input from all the authors. SP obtained original ultrasound images. All authors provided critical feedback and helped shape the manuscript.

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Correspondence to Sarah K. England.

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This article is a contribution to the special issue on Preterm birth: Pathogenesis and clinical consequences revisited - Guest Editors: Anke Diemert and Petra Arck

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Pizzella, S., El Helou, N., Chubiz, J. et al. Evolving cervical imaging technologies to predict preterm birth. Semin Immunopathol 42, 385–396 (2020). https://doi.org/10.1007/s00281-020-00800-5

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