Cost-effectiveness of transvaginal ultrasound cervical length screening in singletons without a prior preterm birth: an update

Werner, Erika F.; Hamel, Maureen S.; Orzechowski, Kelly; Berghella, Vincenzo; Thung, Stephen

doi:10.1016/j.ajog.2015.06.020

Cited by 84 publications

(67 citation statements)

References 18 publications

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“…7, 9, 13, 14 In a recent reevaluation of cost effectiveness, screening remained cost effective, but was no longer cost saving when the prevalence of cervical length ≤ 20 mm was ≤0.83%. 20 The rate of preterm birth before 34 weeks among those screened with a short cervix in the updated cost effectiveness model was 25.8%. 20 While the incidence of short cervix in our cohort was higher than that used in the updated cost effectiveness model, the rate of preterm birth before 34 weeks among those with a short cervix in our cohort was higher at 36.5%.…”

Section: Commentmentioning

confidence: 98%

Universal cervical length screening: implementation and outcomes

Temming

Durst

Tuuli

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Transvaginal measurement of cervical length has been advocated as a screening tool to prevent preterm birth, but controversy remains regarding the overall utility of universal screening. Objective We aimed to evaluate the acceptability of a universal cervical length screening program. Additionally we evaluated risk factors associated with declining screening and subsequent delivery outcomes of women who accepted or declined screening. Study Design This was a retrospective cohort study of transvaginal cervical length screening at a single institution between July 1, 2011 and December 31, 2014. Institutional protocol recommended transvaginal cervical length measurement at the time of anatomic survey between 17 – 23 weeks in all women with singleton, viable pregnancies, without current or planned cerclage, with patients able to opt-out. Patients with cervical length ≤ 20 mm were considered to have clinically significant cervical shortening and were offered treatment. We assessed acceptance rate, risk factors for declining cervical length screening, and the trend of acceptance of cervical length screening over time. We also calculated the prevalence of cervical length ≤ 25, ≤ 20, and ≤ 15 mm, and estimated the association between cervical length screening and spontaneous preterm birth. Results Of 12,740 women undergoing anatomic survey during the study period, 10,871 (85.3%, 95% CI 84.7%, 85.9%) underwent cervical length screening. Of those, 215 (2.0%) had a cervical length ≤25 millimeters and 131 (1.2%) had a cervical length ≤20 millimeters. After the first six months of implementation, there was no change in rates of acceptance of cervical length screening over time (p for trend=0.15). Women were more likely to decline cervical length screening if they were African American (aOR 2.17 95% CI 1.93,2.44), obese (aOR 1.18, 95% CI 1.06,1.31), multiparous (aOR 1.45, 95% CI 1.29,1.64), younger than 35 years (aOR 1.24, 95% CI 1.08,1.43), or smoked (aOR 1.42, 95% CI 1.20,1.68). Rates of spontaneous preterm birth before 28 weeks were higher in those who declined cervical length screening (aOR 2.01, 95% CI 1.33, 3.02). Conclusion Universal cervical length screening was implemented successfully with 85% of women screened. Overall incidence of short cervix was low and women with significant risk factors for preterm birth were more likely to decline screening. Patients who declined cervical length screening were more likely to be African American, obese, multiparous, younger than age 35, and to smoke. Rates of early, but not late, spontaneous preterm birth were significantly higher among women who did not undergo cervical length screening.

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Section: Commentmentioning

confidence: 98%

Universal cervical length screening: implementation and outcomes

Temming

Durst

Tuuli

et al. 2016

American Journal of Obstetrics and Gynecology

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“…Vaginal progesterone is 50 In light of these benefits, universal CL screening seems to be cost-effective. 54,55 We recommend universal cervical length screening to all women at 18 to 24 weeks of gestation. This imaging usually occurs at the same visit as the patient's anatomic survey.…”

Section: Screening CL Measurementsmentioning

confidence: 99%

Measuring the Cervical Length

Markham

Iams²

2016

Clinical Obstetrics &Amp; Gynecology

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An important step toward the goal of eradicating spontaneous preterm birth was achieved with the advent of cervical sonography, a tool that advanced our knowledge of the entity of preterm parturition, improved our ability to detect women at risk for early delivery, and allowed us to prevent some of these premature births. We will describe here the correct technique for obtaining such measurements and will review the literature regarding the use of this tool in specific pregnant populations.

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“…Even when the incidence of a short CL in this population is as low as 1%, TVUS CL screening remains costeffective and may result in a reduction of approximately 20% of all sPTBs. 23 Opponents of universal screening cite concerns about the lack of access to TVU probes and burdens associated with screening including the need for a chaperone duringthescan,timeandequipmentneeded to sanitizate the transvaginal probe, expanding patient appointment times, inconsistency of screening in uncontrolled environments, overdiagnosis or underdiagnosis of cervical shortening if performed by untrained clinicians, a lack of standardized treatment protocols, and a lack of FDA approval of vaginal progesterone for the indication of a short cervix. 5 There are no randomized trials comparing the effectiveness of universal TVU CL screening for a shortcervixwithsubsequenttreatmentwith vaginal progesterone against no screening.…”

Section: Screening In Asymptomatic Women At a Low Risk For Sptbmentioning

confidence: 99%

“…5 The only evidence to support universal TVU CL screening in low-risk women is based on the findings of 4 cost-effectiveness studieswhichshowTVUCLscreeningtobe cost effective and cost-saving compared with no screening and compared with other screeningmethods,evenwhentheincidence of a short cervix is as low as 1%. [23][24][25][26] National organizations such as the Society for Maternal Fetal Medicine and the Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.…”

Section: Screening In Asymptomatic Women At a Low Risk For Sptbmentioning

confidence: 99%

Cervical Length Screening in Asymptomatic Women at High Risk and Low Risk for Spontaneous Preterm Birth

Orzechowski

Boelig

Berghella

2016

Clinical Obstetrics &Amp; Gynecology

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Cervical length (CL) screening should be offered to singletons because there are interventions for those with a short CL. A transvaginal ultrasound (TVU) is the ''gold standard'' for CL. In singletons with prior spontaneous preterm birth, serial TVU CL screening isrecommended between16and236/7weeks. Universal TVU CL screening between 18 and 24 weeks may be considered for low-risk singletons with the administration of vaginal progesterone for TVU CLr20 mm; alternatively, transabdominal ultrasound CL screening may be considered with reflux to TVU CL screening for a transabdominal ultrasound CL<35 mm or inadequate visualization. CL screening is not recommended in multiples.

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Cost-effectiveness of transvaginal ultrasound cervical length screening in singletons without a prior preterm birth: an update

Cited by 84 publications

References 18 publications

Universal cervical length screening: implementation and outcomes

Universal cervical length screening: implementation and outcomes

Measuring the Cervical Length

Cervical Length Screening in Asymptomatic Women at High Risk and Low Risk for Spontaneous Preterm Birth

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