A universal mid-trimester transvaginal cervical length screening program and its associated reduced preterm birth rate

Abstract

Background: Mid-trimester transvaginal cervical length assessment can identify women who are at risk of preterm birth and afford opportunities for preterm birth prevention. However, the incidence of a short cervix is low, and some physicians have questioned whether a universal screening program among women without a previous preterm birth would be beneficial.

Objective: The purpose of this study was to examine whether the introduction of a universal transvaginal cervical length screening program is associated with a reduction in the preterm birth rate.

Study design: This is a cohort study of women with singleton gestations and without any previous preterm births who underwent an obstetric sonogram at 18-24 weeks of gestation and who had their delivery at a single tertiary institution from January 2007 to January 2014. In July 2011, a program was implemented in which all pregnant women who had a sonogram at 18-24 weeks of gestation were to receive a transvaginal cervical length measurement. The preterm birth rates were compared before and after the implementation of the universal cervical length screening program. Multivariable analysis was used to identify whether the universal cervical length screening program was associated independently with the frequency of preterm birth. The Breslow-Day test for homogeneity was used to assess whether any interaction existed in the association based on parity.

Results: Of 64,207 eligible women, 46,598 underwent their mid-trimester sonogram before the universal cervical length screening program, and 17,609 underwent a sonogram after implementation of the program. Of the 17,590 women (99.9%) who agreed to cervical length measurement, 157 (0.89%) had a measurement of ≤25 mm. The introduction of the cervical length program was associated with a significant decrease in the frequency of preterm birth at <37 weeks of gestation (6.7% vs 6.0%; adjusted odds ratio, 0.82 [95% confidence interval, 0.76-0.88]), <34 weeks of gestation (1.9% vs 1.7%; adjusted odds ratio, 0.74 [95% confidence interval, 0.64-0.85]), and <32 weeks of gestation (1.1% vs 1.0%; adjusted odds ratio, 0.74 (95% confidence interval, 0.62-0.90]). This reduction in frequency of preterm birth primarily was due to a change in spontaneous (and not medically indicated) preterm births. The effect size for the reduction in preterm birth was similar in nulliparous and multiparous women with previous term births.

Conclusion: The introduction of a universal transvaginal cervical length screening program in women without a history of preterm birth is associated with a reduction in the frequency of preterm birth.

Keywords: no previous preterm birth; preterm birth rate; transvaginal cervical length; universal screening program.