Characterization of Cervical Remodeling During Pregnancy and the Postpartum Period: A Case Series Analysis

BACKGROUND The uterine cervix is crucial for maintaining pregnancy to term, and complete cervical repair is essential to prevent future obstetric complications. Despite the importance of the cervical remodeling process, its characterization from pregnancy to the postpartum period in humans has been challenging. Quantitative ultrasound (QUS) noninvasively estimates tissue properties, potentially providing insights into the cervical remodeling process beyond standard clinical assessment. By characterizing biological changes throughout pregnancy and the postpartum period, QUS can potentially improve our understanding of normal cervical remodeling and early deviations that can be associated with adverse outcomes. CASE REPORT This retrospective case series was aimed to characterize the cervical remodeling process from pregnancy to 1 year postpartum. Eight women underwent transvaginal ultrasound scans at 2 time points in mid-pregnancy (approximately 20 and 24 weeks of gestation) and 5 time points postpartum (approximately 6 weeks, and 3, 6, 9, and 12 months). Five QUS biomarkers were analyzed: attenuation coefficient, backscatter coefficient, shear wave speed, slope, and intercept. Similar trends were observed in attenuation coefficient, backscatter coefficient, and slope over time. During pregnancy, lower shear wave speed values were detected (mean [SD], 1.6 [0.3] m/s) that increased after delivery (3.2 [0.2] m/s). Additionally, intercept values were higher during both pregnancy time points (-33.3 [0.52] dB) and decreased postpartum (-36.1 [0.45] dB). CONCLUSIONS This case series provides data on the cervical tissue changes observed in 8 participants measured using QUS. These preliminary findings can inform future studies aimed at understanding cervical remodeling and its clinical implications based on cervical tissue changes.