Implementation of universal screening for preterm delivery by mid‐trimester cervical‐length measurement

Souka, Athena P.; Papastefanou, Ioannis; Pilalis, Athanasios; Kassanos, Dimitrios; Papadopoulos, George

doi:10.1002/uog.19050

Cited by 24 publications

(24 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our cohort presents 4% (179) of spontaneous PTB, and this prevalence is similar to that of other studies regarding screening and treatment. 27,29,30 A second assumption needed to implement a screening process is the existence of a test able to detect the high-risk population, and the TUCL satisfies this requirement. An inverse association between the TUCL and PTB, which was also observed in our study, has been widely documented.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Routine Transvaginal Ultrasound Measurement of the Cervical Length on the Prediction of Preterm Birth: A Retrospective Study in a Tertiary Hospital

Almeida

Bartosch

Matias

2021

Rev Bras Ginecol Obstet

View full text Add to dashboard Cite

Preterm birth (PTB) is a major obstetric problem associated with high rates of neonatal morbidity and mortality. The prevalence of PTB has not changed in the last decade; thus, the establishment of a screening test and effective treatment are warranted. Transvaginal ultrasound measurement of the cervical length (TUCL) has been proposed as an effective method to screen pregnant women at a higher risk of experiencing PTB. Objective To evaluate the applicability and usefulness of second-trimester TUCL to predict PTB in a cohort of Portuguese pregnant women. Methods Retrospective cross-sectional cohort study including all singleton pregnant women who performed their second-trimester ultrasound (between weeks 18 and 22 + 6 days) from January 2013 to October 2017 at Centro Hospitalar Universitário São João. Results Our cohort included 4,481 women. The prevalence of spontaneous PTB was of 4.0%, with 0.7% occurring before the 34th week of gestation. The mean TUCL was of 33.8 mm, and percentiles 3, 5 and 10 corresponded to TUCLs of 25.0 mm, 27.0 mm and 29.0 mm respectively. The multiple logistic regression analysis, including maternal age, previous PTB and cervical surgery showed a significant negative association between TUCL and PTB, with an odds ratio (OR) of 0.92 (95% confidence interval [95%CI]: 0.90–0.95; p < 0.001). The use of a TUCL of 20 mm is the best cut-off, when compared with the 25-mm cut-off, improving the prediction of risk. Conclusion The present study showed an inverse association between TUCL and PTB, and that the inclusion of other risk factors like maternal age, previous PTB and cervical surgery can improve the screening algorithm. Furthermore, it emphasizes that the TUCL cut-off that defines short cervix can differ according to the population.

show abstract

Section: Discussionmentioning

confidence: 99%

The Impact of Routine Transvaginal Ultrasound Measurement of the Cervical Length on the Prediction of Preterm Birth: A Retrospective Study in a Tertiary Hospital

Almeida

Bartosch

Matias

2021

Rev Bras Ginecol Obstet

View full text Add to dashboard Cite

show abstract

“…Our own experience from a cohort of about 10 000 screened singleton pregnancies suggests that progesterone therapy may not be as effective in women with CL < 10 mm as it is in women with CL between 10 and 20 mm 18 …”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14][15][16] Inadvertently, several institutions have started to offer screening for preterm delivery in mid-trimester with conflicting results regarding the effectiveness of such programs. [16][17][18] The result of this policy is the identification of a group of women with a short cervix and no other risk factors for SPD. Evidence arising from randomized trials suggests that vaginal progesterone is beneficial for this group.…”

Section: Introductionmentioning

confidence: 99%

“…Measuring cervical length (CL) by transvaginal sonography is strongly predictive of SPD in high‐risk pregnancies as well as in low‐risk women 6‐16 . Inadvertently, several institutions have started to offer screening for preterm delivery in mid‐trimester with conflicting results regarding the effectiveness of such programs 16‐18 . The result of this policy is the identification of a group of women with a short cervix and no other risk factors for SPD.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Very short cervix in low‐risk asymptomatic singleton pregnancies: Outcome according to treatment and cervical length at diagnosis

Souka

Papamihail²,

Pilalis

2020

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Introduction: The aim of this study was to explore the outcome of low-risk singleton pregnancies with very short cervical length (CL ≤15 mm) according to method of treatment and CL at diagnosis. Material and methods: Retrospective study on singleton pregnancies devoid of risk factors for spontaneous preterm delivery identified in the course of universal screening programs by vaginal sonography at 20-24 weeks of gestation to have very short CL ≤ 15 mm. Results: The study group consisted of 233 pregnancies with CL ≤ 15 mm of which 88 had cervical cerclage inserted and the remaining 145 were treated with vaginal progesterone. Mean CL at diagnosis was significantly shorter in the cerclage group (5 mm) compared with the progesterone group (12 mm). Regardless of treatment there was no difference in the rate of spontaneous preterm delivery at <32 weeks of gestation in women with CL ≥ 9 mm at screening (11% and 12% in the cerclage and progesterone groups, respectively). In contrast, in the subgroup with CL ≤ 8 mm cervical cerclage resulted in significantly lower rates of spontaneous preterm delivery at <32 weeks of gestation compared with progesterone treatment (20% and 45%, respectively, P = .009) and the median gestational age at birth was significantly greater (37 weeks vs 36 weeks, respectively, P = .013). Conclusions: The majority of asymptomatic singleton pregnancies with short CL will remain undelivered until 32 weeks of gestation whether treated with progesterone or cerclage. Women with extreme cervical shortening appear to benefit more from cervical cerclage.

show abstract

“…[12][13][14][15] This finding has prompted consideration of universal ultrasound screening for short cervix. 6,16,17 However, there is currently limited data available regarding the predictive value of midtrimester CL in low-risk nulliparous women. By convention, the 10th percentile of CL for the population has been used to indicate women at "high risk" of sPTB, but the 25 mm cut-off has been established in populations at higher risk of PTB, including parous women with prior history of sPTB.…”

mentioning

confidence: 99%

Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix?

et al. 2021

View full text Add to dashboard Cite

Objective The study aimed to estimate the predictive value of midtrimester cervical length (CL) and the optimal cut-off of CL that should be applied with asymptomatic nulliparous women for the prediction of spontaneous preterm birth (sPTB). Study Design This is a prospective cohort study of asymptomatic nulliparous women with a singleton gestation. Participants underwent CL measurement by transvaginal ultrasound between 20 and 24 weeks of gestation. The participants and their health care providers remained blinded to the results of CL measurement. The primary outcomes were sPTB before 35 weeks and sPTB before 37 weeks. Receiver operating characteristics (ROC) curve analyses were performed. Analyses were repeated by using multiples of median (MoM) of CL adjusted for gestational age. Results Of 796 participants, the mean midtrimester CL was 40 ± 6 mm with a 1st, 5th, and 10th percentile of 25, 29, and 32 mm, respectively. ROC curve analyses suggest that a cut-off of 30 mm was the optimal CL to predict sPTB before 35 weeks (area under the ROC curve [AUC]: 0.70, 95% confidence interval [CI]: 0.56–0.85) and before 37 weeks (AUC: 0.70, 95% CI: 0.59–0.80). Midtrimester CL <30 mm could detect 35% of all sPTB before 35 weeks at a false-positive rate of 5% (relative risk: 9.1, 95% CI: 3.5–23.5, p < 0.001). We observed similar results using a cut-off of CL <0.75 MoM adjusted for gestational age. Conclusion A midtrimester CL cut-off of 30 mm (instead of 25 mm), or CL less than 0.75 MoM, should be used to identify nulliparous women at high risk of sPTB. Key Points

show abstract

Implementation of universal screening for preterm delivery by mid‐trimester cervical‐length measurement

Abstract: Universal screening for preterm delivery by vaginal sonography at 20-24 weeks is feasible and well accepted by pregnant women. This policy identifies a very high risk group that may benefit from intervention.

Cited by 24 publications

References 28 publications

The Impact of Routine Transvaginal Ultrasound Measurement of the Cervical Length on the Prediction of Preterm Birth: A Retrospective Study in a Tertiary Hospital

The Impact of Routine Transvaginal Ultrasound Measurement of the Cervical Length on the Prediction of Preterm Birth: A Retrospective Study in a Tertiary Hospital

Very short cervix in low‐risk asymptomatic singleton pregnancies: Outcome according to treatment and cervical length at diagnosis

Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix?

Contact Info

Product

Resources

About