Evolving cervical imaging technologies to predict preterm birth
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REVIEW
Evolving cervical imaging technologies to predict preterm birth Stephanie Pizzella 1 & Nicole El Helou 1 & Jessica Chubiz 1 & Lihong V. Wang 2 & Methodius G. Tuuli 3 & Sarah K. England 1 Molly J. Stout 1
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Received: 3 March 2020 / Accepted: 18 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Preterm birth . Cervical remodeling . Ultrasound . Elastography
Introduction Each year, preterm birth, defined as delivery before 37 weeks’ gestation, affects approximately 15 million babies and causes roughly one million deaths in children under the age of five [1, 2]. Those who survive face a lifetime of adverse health outcomes, such as blindness, deafness, respiratory difficulties,
This article is a contribution to the special issue on Preterm birth: Pathogenesis and clinical consequences revisited - Guest Editors: Anke Diemert and Petra Arck * Sarah K. England [email protected] 1
Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Andrew and Peggy Cherng Department of Medical Engineering, Department of Electrical Engineering, California Institute of Technology, Pasadena, CA, USA
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Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
and cognitive disabilities [2]. As of 2005, more than $26 billion is spent each year to hospitalize premature infants in the USA [2]. The financial burden of preterm birth
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