Amer J Perinatol
DOI: 10.1055/s-0037-1607286
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ultrasonic Assessment of Cervical Heterogeneity for Prediction of Spontaneous Preterm Birth: A Feasibility Study

Sarah L. Pachtman1, Sleiman R. Ghorayeb2, 3, 4, 5, Matthew J. Blitz1, Kemoy Harris1, Nidhi Vohra1, Cristina P. Sison5, 6, Burton L. Rochelson1
  • 1Division of Maternal-Fetal Medicine, Hofstra Northwell School of Medicine, North Shore University Hospital, Manhasset, New York
  • 2Department of Radiology, Hofstra Northwell School of Medicine, Hempstead, New York
  • 3Ultrasound Research Laboratory, School of Engineering and Applied Sciences, Hofstra University, Hempstead, New York
  • 4Feinstein Institute for Medical Research, Center for Immunology and Inflammation, Manhasset, New York
  • 5Department of Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York
  • 6Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, New York
Further Information

Publication History

25 August 2017

04 September 2017

Publication Date:
10 October 2017 (eFirst)


Background In a normal pregnancy, cervical collagen fibers remain organized in predictable patterns throughout most of the gestation. Cervical remodeling reflects a rearrangement of collagen fibers in which they become increasingly disordered and contribute to the pathogenesis of spontaneous preterm birth. Quantitative ultrasound analysis of cervical tissue echotexture may have the capacity to identify microstructural changes before the onset of cervical shortening.

Objectives The primary objective of this study was to examine the utility of a novel quantitative sonographic marker, the cervical heterogeneity index (HI), which reflects the relative organization of cervical collagen fibers. Also, we aimed to determine an optimal HI cut-point to predict spontaneous preterm birth.

Study Design This retrospective cohort study employed a novel image-processing technique on transvaginal ultrasound images of the cervix in gestations between 14 and 28 completed weeks. The transvaginal sonography images were analyzed in MATLAB (MathWorks, Natick, MA) using a custom image-processing technique that assessed the relative heterogeneity of the cervical tissue.

Results A total of 151 subjects were included in the study. The mean HI in subjects who delivered preterm and at term was 8.28 ± 3.73 and 12.35 ± 5.80, respectively (p < 0.0001). Thus, decreased tissue heterogeneity was associated with preterm birth, and increased tissue heterogeneity was associated with delivery at term. In our study population, preterm birth was associated with a short cervix (<2.5 cm), history of preterm birth and lower HI, and our findings indicate that HI may improve prediction of preterm birth.

Conclusion Quantitative ultrasound measurement of the cervical HI is a promising, noninvasive tool for early prediction of spontaneous preterm birth.


This study was presented at the 37th Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine; January 23–28, 2017; Las Vegas, NV.