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Objective: To determine whether a soft cervix identified by shear-wave elastography between 18 and 24 weeks of gestation is associated with increased frequency of spontaneous preterm delivery (sPTD). Materials and methods: This prospective cohort study included 628 consecutive women with a singleton pregnancy. Cervical length (mm) and softness [shear-wave speed: (SWS) meters per second (m/s)] of the internal cervical os were measured at 18–24 weeks of gestation. Frequency of sPTD &lt;37 (sPTD&lt;37) and &lt;34 (sPTD&lt;34) weeks of gestation was compared among women with and without a short (≤25 mm) and/or a soft cervix (SWS &lt;25 th  percentile). Results: There were 31/628 (4.9%) sPTD&lt;37 and 12/628 (1.9%) sPTD&lt;34 deliveries. The combination of a soft and a short cervix increased the risk of sPTD&lt;37 by 18-fold [relative risk (RR) 18.0 (95% confidence interval [CI], 7.7–43.9); P&lt;0.0001] and the risk of sPTD&lt;34 by 120-fold [RR 120.0 (95% CI 12.3–1009.9); P&lt;0.0001] compared to women with normal cervical length. A soft-only cervix increased the risk of sPTD&lt;37 by 4.5-fold [RR 4.5 (95% CI 2.1–9.8); P=0.0002] and of sPTD&lt;34 by 21-fold [RR 21.0 (95% CI 2.6–169.3); P=0.0003] compared to a non-soft cervix. Conclusions: A soft cervix at 18–24 weeks of gestation increases the risk of sPTD &lt;37 and &lt;34 weeks of gestation independently of cervical length.

journal of perinatal medicine

A soft cervix, categorized by shear-wave elastography, in women with short or with normal cervical length at 18–24 weeks is associated with a higher prevalence of spontaneous preterm delivery