Objectives: Fetal growth restriction (FGR), commonly caused by placental insufficiency, is a critical obstetric condition requiring accurate and timely detection to mitigate adverse outcomes. Placental sonoelastography, an advanced ultrasound technique that evaluates tissue stiffness, has emerged as a promising tool for assessing placental health.

Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines to evaluate the usefulness of placental elastography in FGR. We performed a comprehensive search of PubMed, Embase, Scopus, and Web of Science up to January 2025 for in-vivo studies comparing placental elastography in the FGR and healthy control groups. Data from the included studies were pooled using random-effects models to calculate standardized mean differences (SMD) and mean differences (MD) in placental stiffness. Additionally, correlation coefficients were pooled, and diagnostic accuracy metrics, including sensitivity and specificity, were synthesized using a bivariate random-effects model.

Results: A total of 14 studies were included in the systematic review. The meta-analysis revealed significantly increased placental stiffness in FGR pregnancies. For Young's modulus, the pooled analysis of 9 studies yielded an SMD of 2.51 (95% CI: 0.72-4.30). For shear wave velocity, the pooled analysis of 6 studies revealed an SMD of 1.55 (95% CI: 0.83-2.28). Significant heterogeneity was noted in these analyses. Pooled data from 3 studies demonstrated a significant negative correlation between placental stiffness and birth weight (r = -0.453). The diagnostic accuracy, assessed from 4 studies, was high, with a pooled sensitivity of 92.0% and specificity of 98.9%.

Discussion: Placental sonoelastography stands out as a powerful, non-invasive technique that could significantly enhance the clinical assessment and surveillance of pregnancies at risk for FGR, potentially leading to more timely and effective interventions. This quantitative measure not only distinguishes FGR cases from healthy pregnancies with high accuracy but also correlates with meaningful neonatal outcomes.