The Emerging Role of Sonoelastography in Pregnancy: Applications in Assessing Maternal and Fetal Health

Abstract

Sonoelastography, a novel ultrasound-based technique, is emerging as a valuable tool in prenatal diagnostics by quantifying tissue elasticity and stiffness in vivo. This narrative review explores the application of sonoelastography in assessing maternal and fetal health, with a focus on cervical, placental, pelvic floor, and fetal tissue evaluations. In the cervix, sonoelastography aids in predicting preterm birth and assessing labor induction success. For the placenta, it provides insights into conditions like preeclampsia and intrauterine growth restriction through elasticity measurements. Assessing fetal tissues, including the lungs, liver, and brain, sonoelastography offers a non-invasive method for evaluating organ maturity and detecting developmental anomalies. Additionally, pelvic floor assessments enable better management of childbirth-related injuries and postpartum recovery. While current studies support its safety when used within established limits, further research is necessary to confirm long-term effects. Future advancements include refining protocols, integrating machine learning, and combining sonoelastography with other diagnostic methods to enhance its predictive power. Sonoelastography holds promise as an impactful adjunct to conventional ultrasound, providing quantitative insights that can improve maternal and fetal outcomes in prenatal care.

Keywords: cervical elasticity; fetal tissue assessment; maternal–fetal health; pelvic floor; placental stiffness; prenatal diagnosis; preterm birth prediction; shear wave elastography; sonoelastography; ultrasound imaging.

Figure 3

Shear wave elastography of the levator ani muscle at rest (a) and during a Valsalva maneuver (b). Image adapted from Gachon et al. [56] under a Creative Commons Attribution 4.0 International License. Changes were made to resize and adjust the images.

Figure 1

(a) Shear wave elastography image from a 26-year-old woman at 35 weeks gestation, showing high stiffness (11.1 kPa) in the anterior internal os; this patient delivered naturally at 38 + 4 weeks. (b) Shear wave elastography image from a 31-year-old woman at 34 weeks gestation, showing reduced stiffness (4.8 kPa) in the anterior internal os; this patient experienced preterm birth at 35 + 2 weeks due to premature rupture of membranes. Image adapted from Smith et al. [25] under a Creative Commons Attribution 4.0 International License. Changes were made to resize and adjust the images.

Figure 2

A pregnant woman with placenta percreta showing (a) increased average shear wave velocity (1.95 m/s) in comparison to a pregnant woman with normal placenta showing (b) normal average shear wave velocity (1.83 m/s). Reproduced with permission from Sage. © 2024.

Figure 4

Normal shear wave elastography images of fetal lung (a) and liver (b) with elasticity values of 4.43 kPa and 5.09 kPa, respectively. Image adapted from Liu et al. [67] under a Creative Commons Attribution 4.0 International License. Changes were made to resize and adjust the images.