Premature contractions: possible influence of sonographic measurement of cervical length on clinical management

Abstract

In a retrospective case control study with historical controls, the influence of the introduction of vaginal sonographic cervical length measurement on the utilization of hospital services and pregnancy outcome of gravid women at risk of preterm delivery was examined. Prior to the introduction of vaginal ultrasonography to measure cervical length, we registered 76 hospitalizations totalling 1827 hospitalization days due to premature cervical ripening and/or premature labor in 1991 and 1992. In 1994 and 1995, after vaginal ultrasonography was introduced and intravenous tocolysis was limited to cases with cervical shortening to less than 3 cm, there were 64 admissions resulting in just 869 hospitalization days. Long-term hospitalizations (over 10 days) were reduced from 55 to 25 cases (p < 0.0001) and the median length of hospital stay decreased from 18 to 8 days (p < 0.0001). The number of preterm births (< or = 37 weeks) remained stable: 12 cases in 1991-1992 and 13 cases in 1994-1995. In conclusion, vaginal sonographic measurement of cervical length provides an objective criterion for cervical shortening with premature labor. The method could therefore be a suitable means of reducing unnecessary therapeutic interventions in gravid women with premature contractions and/or cervical dilatation. A prospective randomized trial to confirm these findings is suggested.

Uterine Cervical Length Measurement to Reduce Length of Stay in Patients Admitted for Threatened Preterm Labor: A Randomized Trial

“…Moreover, they are consistent with other nonrandomized reports in which clinical protocols incorporating ultrasound assessment of CL were shown to be useful in avoiding unnecessary prolonged hospitalization and in reducing the mean hospital stay by about 2 days [17,18,20]. Our study also showed that management of hospitalized women with ultrasound was independently associated with shorter stay and that GA at admission was also associated with length of stay.…”

“…The extent to which this knowledge could be translated into healthcare costs savings is out of the scope of this study and requires careful evaluation by cost estimates, including those incurred by the use of ultrasound scans. Even though a 1-day reduction might not seem that relevant, in nonresearch conditions the impact of this approach could be greater as other studies have described a much longer length of stay compared to ours [18,20,25,26]. In fact, a recent descriptive study by Lucovnik et al [5] demonstrated that unnecessary admissions and treatments related to threatened preterm birth significantly contribute to healthcare costs.…”

“…To our knowledge, up to now only nonrandomized approaches to the topic have been published [17,18,20]. However, we acknowledge some limitations.…”

“…Previous reports provided nonrandomized evidence that the use of clinical protocols incorporating ultrasound assessment of CL in hospitalized women may be associated with a significant reduction in hospital stay for threatened preterm labor [17][18][19][20]. However, randomized clinical trials are needed to support these data.…”

Place de l’échographie en salle de naissance

“…Dans une comparaison historique, Rageth et al [13] ont montré que le taux d'hospitalisation et surtout la durée de celleci avaient diminué après introduction de l'échographie du col (1994)(1995) versus (1991)(1992). Le nombre de patientes hospitalisées plus de dix jours pour menace d'accouchement prématuré était ainsi passé de 55 à 25 ( p < 0,0001).…”