Cervical Elastography as a Predictive Tool for Preterm Birth: A Systematic Review and Meta-analysis.

Cervical elastography, including strain elastography (SE) and shear wave elastography (SWE), is an emerging ultrasound technique for assessing cervical stiffness, potentially enabling earlier prediction of spontaneous preterm birth than conventional sonographic measurements. However, its diagnostic performance and optimal application timing remain unclear. A systematic review and meta-analysis was conducted to evaluate the diagnostic accuracy of cervical elastography for predicting spontaneous preterm birth. Databases were searched for studies published between January 2014 and March 2025. Eligible studies assessed SE or SWE in pregnant women and reported sensitivity, specificity, and/or area under the receiver operating characteristic curve (AUC) for spontaneous preterm birth prediction. Data were extracted, and pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and AUC were calculated using a random-effects model. Subgroup analyses explored differences between SE and SWE and the influence of gestational age at assessment. Thirteen studies (n = 4,087 women) met the inclusion criteria. The pooled sensitivity was 77.1% (95% confidence interval (CI): 72.0-81.5), specificity 73.3% (95% CI: 66.4-79.3), and AUC 0.82 (95% CI: 0.78-0.85), with a pooled DOR of 11.05 (95% CI: 6.85-17.83). Subgroup analysis indicated that SWE tended to yield higher sensitivity in later gestation, whereas SE showed relatively better performance in early to mid-trimester assessments. Cervical elastography demonstrated moderate to good diagnostic accuracy for predicting sPTB. SE and SWE may have complementary roles depending on gestational age, supporting their potential integration into risk assessment strategies for preterm birth prevention.