Low-Field Magnetic Resonance Imaging of the Late Gestation Cervix and Birth Outcome Correlation: A Prospective Cohort Study.

Journal: BJOG : an international journal of obstetrics and gynaecology
Published Date: Dec 3, 2025

Abstract

OBJECTIVE: To use low-field MRI to produce reconstructions and 3D models of the cervix and to automate measurements for correlation with demographics and birth outcomes. DESIGN: Prospective cohort study. SETTING: KCL Advanced Imaging Centre, St Thomas's Hospital. POPULATION: Late gestation (36-41w) women attempting their first vaginal birth, recruited to the MiBirth study (n = 97). METHODS: Reconstructed images were produced from 2D T2-weighted Turbo-Spin-Echo 2D sequences acquired with a 0.55 T Freemax MRI scanner. Segmentations and anatomical landmarks were automated using an in-house 3D deep learning segmentation network, from which cervical 2D measurements and 3D volumes were generated. MAIN OUTCOME MEASURES: Quality of reconstructed images and segmentations. Inter-rater variability for cervical biometry. Correlation between cervical measurements, maternal demographics and birth outcomes. RESULTS: Successful reconstructions were obtained for 92.9%; 84.9% were good quality. Excellent or good quality segmentations were obtained for all successful reconstructions (n = 99). Inter-rater variability between automated and manual biometry was excellent or good for cervical measurements. Total cervical and stroma volumes significantly increased with cervical length (p < 0.01). Os diameters and utero-cervical angle significantly decreased as cervical length increased (p < 0.001). Cervical stroma volume increased with maternal age (p = 0.02). Controlling for maternal age, an increased cervical volume was associated with an increased risk of caesarean section (OR 1.09, p = 0.04). CONCLUSIONS: This is a novel, accurate automated system to assess MRI late gestation cervical biometry and volumetry. We have shown that the late gestation cervical phenotype may influence birth outcomes and provided a new mechanism for increased risk of caesarean with maternal age.

Authors

  • Simi Bansal
    Department of Early Life Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK.
  • Alena U Uus
    School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
  • Agnieszka Glazewska-Hallin
    Reseach Department for Early Life Imaging, King's College London, London, UK.
  • Caitlin Allwin
    School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
  • Hadi Waheed
    Reseach Department for Early Life Imaging, King's College London, London, UK.
  • Vanessa Kyriakopoulou
    Department of Early Life Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK.
  • Anna L David
  • Dimitrios Siassakos
    Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
  • Manju Chandiramani
    Reseach Department for Early Life Imaging, King's College London, London, UK.
  • Jana Hutter
    Department of Early Life Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK.
  • Lisa Story
    Department of Early Life Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK.
  • Mary A Rutherford

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