**4. Premature/preterm cervical microstructure remodeling assessment**

The current approach to evaluating cervix state relies on digital assess (with Bishop scoring [87], first proposed for labor induction success), subjective appreciation as "soft, medium, hard/firm", and conventional sonographic examination [54] being now compelling evidence that changes in viscoelastic properties are key to cervix function. Cervical length (CL) measurements are suboptimal means to assess early remodeling, providing no data on consistency [88], and because of high negative predictive value, when used as a screening test [89]. Some studies tried to give indirect data on cervical softness during conventional sonography: cervical sliding sign—assessing cervix resistance to gentle probe compression [90], cervical mucus plug distance—part of the plug nearest to vaginal microflora, as an additional sign for CR [91]. One gives much attention to CL value in asymptomatic cases: ≤15 mm before 20 weeks gestation has a dramatic and significantly higher risk of early PTB than at 20–24 weeks [92] and to differences between universal screening and selective screening in conjunction with independent risk factors for a short cervix ≤25 mm at 20–24 weeks [93]: race-ethnicity; current tobacco use; prior indicated preterm birth; a prior cervical excisional procedure. If only women with any of these variables were offered transvaginal CL screening, the specificity would increase from 62.8% for universal screening to 96.5% with a risk-based approach. The sensitivity with one variable present was 62.8%, and with two factors, 14%. The Cochrane Database Systematic Review [94] on the knowledge of CL in singleton pregnancies with symptoms vs. no knowledge up to the year 2018 showed a prolongation with only 4 days before 34 weeks gestation.

*Abnormal Cervical Remodeling Early Depiction by Ultrasound Elastography: Potential… DOI: http://dx.doi.org/10.5772/intechopen.113314*
