Cervical elastography in the diagnosis of isthmic-cervical insufficiency and assessment of the efficacy of its correction

Objective. To improve the diagnosis of isthmic-cervical insufficiency (ICI) and increase the efficacy of its correction by introducing cervical elastography into the examination of pregnant patients. Patients and methods. This prospective study enrolled 180 patients with a confirmed diagnosis of ICI. Depending on the outcome of pregnancy, all patients were divided into two groups: group 1 (n = 44) included pregnant women in whom ICI correction was ineffective and who had preterm birth; group 2 (n = 136) included patients in whom ICI correction had a positive effect and who had a full-term pregnancy. ICI was diagnosed using transvaginal ultrasound with additional methods such as ultrasound elastography and examination of the composition of the vaginal biocenosis and the sensitivity of the isolated microflora to antibacterial agents. Results. The main factor affecting the efficacy of ICI correction is the baseline length of the cervix. The frequency of preterm birth with a critical cervical length <15 mm is 54.3%, and with a cervical length >20 mm, it is 13.4% (p = 0.001) (OR: 0.841; 0.779–0.908). In addition to the length of the cervix, its stiffness according to elastography is an important parameter. The “soft” type increases the risk of spontaneous preterm birth by 7.4 times (OR: 7.371; 3.083–17.619) (p = 0.001). A combined assessment of the parameters of cervical length and stiffness provides a more accurate prediction of the efficacy of ICI correction. Favorable factors for ICI correction are cervical length of 20 mm or more regardless of cervical stiffness and cervical length of 16–19 mm in combination with “medium” and “hard” types. The most unfavorable combination is a cervical length ≤15 mm with a “soft” type. Conclusion. The introduction of elastography into cervicometry improves the quality of examination and contributes to better perinatal outcomes. Mechanical correction of ICI should be performed in patients with short cervix of 20 mm. The efficacy of ICI treatment also depends on the state of the vaginal biocenosis. Key words: isthmic-cervical insufficiency, cervicometry, elastography, cerclage, obstetric pessary