Quantitative sonoelastography of the uterine cervix in predicting successful outcome of induction of labour

OBJECTIVES: The aim of the study was to evaluate the stiffness of cervix and determine its significance in predicting successful outcome of induction of labour. The primary objective was to determine the differences in elastography indices of different areas of cervix between the outcome groups of successful and failed induction of labour. A secondary objective was to find out the correlation of these elastography indices with Bishop’s score and cervical length. METHODS: This was a prospective, observational study conducted over a period of 6 months on pregnant women admitted in the labour room for induction of labour. Establishment of adequate regular uterine contractions – at least three contractions lasting 40–45 s in a 10-min period – was taken as end point for successful outcome of induction of labour. Even after 24 h of initiation of induction of labour, regular, adequate and painful uterine contractions were not established, then induction of labour was described as having failed. Prior to induction, cervical length measurement, Bishop’s scoring and elastographic evaluation of the cervix were done by stress–strain elastography. A colour map was produced from purple to red and a five-step scale – the elastography index – was used to describe the various parts of the cervix. The differences between elastography indices of different parts of cervix were estimated using Mann–Whitney U test. Correlation of the indices with cervical length and Bishop’s score was determined by Spearman’s correlation coefficient. RESULTS: A total of 64 women were included in the study. A significant difference (p < 0.001) was found in the elastography index of internal os between the two outcome groups of success (1.76 ± 0.64) and failure (0.54 ± 0.18). However, the elastography index of central cervical canal, external os, anterior lip and posterior lips did not differ significantly across the outcome groups. A significant positive correlation was found between elastography index of internal os and cervical length (Spearman’s correlation coefficient, r = 0.441, p < 0.001) and between elastography index of external os and cervical length (r = 0.347, p = 0.005), whereas a negative correlation was seen between elastography index of external os and Bishop’s score (r = −0.270, p = 0.031). CONCLUSION: Elastography index of internal os can be used to predict outcome of induction of labour. Cervical elastography is a promising new technique for cervical consistency assessment. Further larger studies are required to determine some cut-off point for elastography index of internal os in prediction of outcome of induction of labour and to strongly establish the usefulness of cervical elastography for pregnancy management, preventing preterm delivery and establishment of cut-off points to determine successful induction.