Predictive value of E-cervix cervical elastography combined with ultrasonographic parameters for mode of delivery of pregnant women in the third trimester

doi:10.3877/cma.j.issn.1673-5250.2026.02.007

Objective

To investigate the value of transvaginal color Doppler ultrasound combined with E-cervix elastography parameters in predicting the mode of delivery of pregnant women in the third trimester.

Methods

A total of 300 pregnant women who underwent late-pregnancy ultrasound examination at Xi′an Daxing Hospital from January 2022 to December 2024 were retrospectively enrolled. According to the mode of delivery, they were divided into a vaginal delivery group (n=201) and a cesarean delivery group (n=99). Cervical parameters including cervical length (CL), uterocervical angle (UCA), elasticity contrast index (ECI), hardness ratio, internal os strain (IOS), external os strain (EOS), and IOS/EOS were analyzed. Multivariate unconditional logistic regression analysis was performed to identify factors associated with the mode of delivery. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of individual parameters and the combined model. This study was approved by the Medical Ethics Committee of Xi′an Daxing Hospital (Approval No. KY2024-002).

Results

① Compared with the cesarean delivery group, the vaginal delivery group showed significantly lower CL and hardness ratio, and significantly higher UCA, ECI, IOS, and EOS (all P<0.05). ② Multivariate logistic regression analysis demonstrated that CL (OR=4.408, 95%CI: 2.486-7.817, P<0.001) and hardness ratio (OR=1.024, 95%CI: 1.005-1.043, P=0.012) were independent risk factors for cesarean delivery of pregnant women in the third trimester, whereas UCA (OR=0.934, 95%CI: 0.911-0.957, P<0.001) was an independent protective factor. ③ROC curve analysis showed that the area under the curve (AUC) for predicting vaginal delivery was 0.750 for UCA, 0.706 for CL, 0.652 for hardness ratio, 0.617 for IOS, 0.602 for EOS, and 0.596 for ECI. The combined model (UCA, CL, hardness ratio, IOS, EOS, and ECI) achieved an AUC of 0.841 (95%CI: 0.792-0.890), with a sensitivity of 86.1% and a specificity of 73.7%.

Conclusions

Transvaginal color Doppler ultrasound combined with E-cervix elastography can comprehensively evaluate cervical maturity from both anatomical and biomechanical perspectives. A multiparametric combined model demonstrates superior predictive performance compared with single parameters and may provide an objective basis for individualized assessment of delivery mode of pregnant women in the third trimester.

Key words: Cervical elastography, Transvaginal ultrasound, Cervical length, Mode of delivery, Uterocervical angle, Pregnant women

表1 2组晚孕期孕妇的一般临床资料比较

组别	例数	年龄[岁，M(Q₁，Q₃)]	人体质量指数[kg/m²，M(Q₁，Q₃)]	孕龄[周，M(Q₁，Q₃)]	孕次[例数(%)]
组别	例数	年龄[岁，M(Q₁，Q₃)]	人体质量指数[kg/m²，M(Q₁，Q₃)]	孕龄[周，M(Q₁，Q₃)]	1次	≥2次
自然分娩组	201	30.0(27.0，33.0)	26.1(24.8，27.7)	39.6(39.2，40.2)	116(57.8)	85(42.3)
剖宫产术分娩组	99	30.0(27.0，33.0)	26.9(25.2，28.1)	39.5(39.2，40.1)	58(58.6)	41(41.4)
统计量		Z＝1.01	Z＝1.93	Z＝1.25	χ²<0.01
P值		0.314	0.054	0.210	0.984

表1 2组晚孕期孕妇的一般临床资料比较

组别	例数	年龄[岁，M(Q₁，Q₃)]	人体质量指数[kg/m²，M(Q₁，Q₃)]	孕龄[周，M(Q₁，Q₃)]	孕次[例数(%)]
组别	例数	年龄[岁，M(Q₁，Q₃)]	人体质量指数[kg/m²，M(Q₁，Q₃)]	孕龄[周，M(Q₁，Q₃)]	1次	≥2次
自然分娩组	201	30.0(27.0，33.0)	26.1(24.8，27.7)	39.6(39.2，40.2)	116(57.8)	85(42.3)
剖宫产术分娩组	99	30.0(27.0，33.0)	26.9(25.2，28.1)	39.5(39.2，40.1)	58(58.6)	41(41.4)
统计量		Z＝1.01	Z＝1.93	Z＝1.25	χ²<0.01
P值		0.314	0.054	0.210	0.984

图1　本研究1例自然分娩孕妇(27岁，G₁P₀，孕龄为38^＋6孕周)的经阴道彩色多普勒超声声像图[图1A：宫颈弹性成像测量图；图1B：宫颈角测量图(UCA为102.75°，CL为2.51 cm，ECI为5.13，硬度比为34.04%，IOS为0.57，EOS为0.38，IOS/EOS为1.50)]　图2　本研究1例剖宫产术分娩孕妇(35岁，G₂P₁，孕龄为37^＋5孕周)的经阴道彩色多普勒超声声像图[图2A：宫颈弹性成像测量图；图2B：宫颈角测量图(UCA为98.56°，CL为4.00 cm，ECI为5.45，硬度比为39.80%，IOS为0.35，EOS为0.47，IOS/EOS为0.74)]注：UCA为宫颈角，CL为宫颈长度，ECI为弹性对比指数，IOS为宫颈内口应变值，EOS为宫颈外口应变值，IOS/EOS为宫颈内外口应变比值

表2 2组晚孕期孕妇经阴道彩色多普勒超声测量的宫颈参数比较[M(Q₁，Q₃)]

组别	例数	UCA(°)	CL(cm)	ECI	硬度比(%)	IOS	EOS	IOS/EOS
自然分娩组	201	109(102，115)	2.68(2.00, 3.01)	4.00(3.20, 5.13)	39(30, 59)	0.41(0.34, 0.52)	0.35(0.29, 0.43)	1.16(0.88, 1.56)
剖宫产术分娩组	99	97(89，105)	3.01(2.78, 3.28)	3.49(2.80, 4.55)	52(40, 62)	0.37(0.30, 0.43)	0.32(0.25, 0.39)	1.18(0.90, 1.45)
Z值		7.03	5.81	2.70	4.29	3.30	2.87	0.12
P值		<0.001	<0.001	0.007	<0.001	<0.001	0.004	0.884

表2 2组晚孕期孕妇经阴道彩色多普勒超声测量的宫颈参数比较[M(Q₁，Q₃)]

组别	例数	UCA(°)	CL(cm)	ECI	硬度比(%)	IOS	EOS	IOS/EOS
自然分娩组	201	109(102，115)	2.68(2.00, 3.01)	4.00(3.20, 5.13)	39(30, 59)	0.41(0.34, 0.52)	0.35(0.29, 0.43)	1.16(0.88, 1.56)
剖宫产术分娩组	99	97(89，105)	3.01(2.78, 3.28)	3.49(2.80, 4.55)	52(40, 62)	0.37(0.30, 0.43)	0.32(0.25, 0.39)	1.18(0.90, 1.45)
Z值		7.03	5.81	2.70	4.29	3.30	2.87	0.12
P值		<0.001	<0.001	0.007	<0.001	<0.001	0.004	0.884

表3 影响晚孕期孕妇分娩方式因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
硬度比(连续变量)	0.024	0.009	7.111	0.012	1.024	1.005~1.043
EOS(连续变量)	－1.942	1.424	1.860	0.179	0.130	0.008~2.432
CL(连续变量)	1.483	0.292	25.794	<0.001	4.408	2.486~7.817
UCA(连续变量)	－0.069	0.013	28.172	<0.001	0.934	0.911~0.957
IOS(连续变量)	－2.094	1.387	2.279	0.131	0.123	0.008~1.868
ECI(连续变量)	－0.060	0.134	0.200	0.651	0.941	0.724~1.224

表3 影响晚孕期孕妇分娩方式因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
硬度比(连续变量)	0.024	0.009	7.111	0.012	1.024	1.005~1.043
EOS(连续变量)	－1.942	1.424	1.860	0.179	0.130	0.008~2.432
CL(连续变量)	1.483	0.292	25.794	<0.001	4.408	2.486~7.817
UCA(连续变量)	－0.069	0.013	28.172	<0.001	0.934	0.911~0.957
IOS(连续变量)	－2.094	1.387	2.279	0.131	0.123	0.008~1.868
ECI(连续变量)	－0.060	0.134	0.200	0.651	0.941	0.724~1.224

图3 晚孕期孕妇经阴道彩色多普勒超声测量宫颈各参数及其联合预测晚孕期孕妇自然分娩的ROC曲线注：联合指标为UCA、CL、硬度比、IOS、EOS及ECI联合。ROC曲线为受试者工作特征曲线，UCA为子宫颈角，CL为宫颈长度，IOS为宫颈内口应变值，EOS为宫颈外口应变值，ECI为弹性对比指数

表4 晚孕期孕妇经阴道彩色多普勒超声测量宫颈各参数及其联合预测晚孕期孕妇自然分娩的ROC曲线分析结果

预测指标	ROC曲线			最佳临界值	敏感度(%)	特异度(%)
预测指标	AUC	AUC 95%CI	P值	最佳临界值	敏感度(%)	特异度(%)
UCA	0.750	0.690~0.810	<0.001	101.58°	76.1	69.7
CL	0.706	0.647~0.766	<0.001	2.54 cm	43.3	90.9
硬度比	0.652	0.589~0.715	<0.001	35.76%	39.8	85.9
IOS	0.617	0.515~0.684	<0.001	0.41	55.2	65.7
EOS	0.602	0.535~0.669	0.002	0.40	35.8	82.8
ECI	0.596	0.527~0.665	0.003	3.06	81.1	38.4
联合指标^a	0.841	0.792~0.890	<0.001	－	86.1	73.7

表4 晚孕期孕妇经阴道彩色多普勒超声测量宫颈各参数及其联合预测晚孕期孕妇自然分娩的ROC曲线分析结果

预测指标	ROC曲线			最佳临界值	敏感度(%)	特异度(%)
预测指标	AUC	AUC 95%CI	P值	最佳临界值	敏感度(%)	特异度(%)
UCA	0.750	0.690~0.810	<0.001	101.58°	76.1	69.7
CL	0.706	0.647~0.766	<0.001	2.54 cm	43.3	90.9
硬度比	0.652	0.589~0.715	<0.001	35.76%	39.8	85.9
IOS	0.617	0.515~0.684	<0.001	0.41	55.2	65.7
EOS	0.602	0.535~0.669	0.002	0.40	35.8	82.8
ECI	0.596	0.527~0.665	0.003	3.06	81.1	38.4
联合指标^a	0.841	0.792~0.890	<0.001	－	86.1	73.7

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