Is universal cervical length screening indicated in women with prior term birth?

Published:August 28, 2014DOI:


      To determine whether universal transvaginal ultrasound (TVU) cervical length (CL) screening is indicated in women with prior term births.

      Study Design

      We conducted a prospective cohort study from Jan. 1, 2012, to June 30, 2013, of singleton gestations between 18 0/7-23 6/7 weeks undergoing TVU CL screening for prediction of spontaneous preterm birth (sPTB). Women with a prior sPTB, with cerclage, and without delivery data available were excluded. Primary outcomes were the incidence of a CL ≤20 mm, and rates of sPTB <37, <34, and <32 weeks gestation among women with prior term births vs nulliparous women.


      A total of 1569 women underwent TVU CL screening; 18 women with a prior iatrogenic preterm birth were excluded. Of those screened, 756 (48.7%) had a prior term delivery and 795 (51.3%) were nulliparous. Women with prior term births differed from nulliparous women with respect to age, body mass index, race, smoking status, and prior dilation and curettage. After adjustment for these confounders, there was no statistical difference in the incidence of CL ≤20 mm (0.8 vs 1.4%; adjusted odds ratio, 0.35; 95% confidence interval, 0.12–1.03) among women with prior term births compared with nulliparous women. Rates of sPTB <37, <34, <32 weeks were similar in women with a prior term birth compared with nulliparous women. The overall incidence of sPTB <37 weeks was 3.2% in women with a prior term birth and 5.0% in nulliparous women. When a CL ≤20 mm was identified, 3 of 6 women with prior term birth delivered at <37 weeks compared with 8 of 11 nulliparous women. There were no identified differences between the odds of sPTB between women with a CL ≤20 mm who had a prior term birth compared with nulliparous women.


      Women with prior term birth have a trend toward a lower incidence of CL ≤20 mm, compared with nulliparous women. Further studies are needed to determine whether women with prior term births should be included or excluded from TVU CL screening.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Goldenberg R.L.
        • Culhane J.F.
        • Iams J.D.
        • Romero R.
        Epidemiology and causes of preterm birth.
        Lancet. 2008; 371: 74-84
        • Society for Maternal-Fetal Medicine Publications Committee, with assistance of Vincenzo Berghella
        Progesterone and preterm birth prevention: translating clinical trials data into clinical practice.
        Am J Obstet Gynecol. 2012; 206: 376-386
        • Berghella V.
        • Rafael T.J.
        • Szychowski J.M.
        • Rust O.A.
        • Owen J.
        Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis.
        Obstet Gynecol. 2011; 117: 663-671
        • Chauhan S.P.
        • Scardo J.A.
        • Hayes E.
        • Abuhamad A.Z.
        • Berghella V.
        Twins: prevalence, problems, and preterm births.
        Am J Obstet Gynecol. 2010; 203: 305-315
        • Martin J.A.
        • Hamilton B.E.
        • Osterman M.
        • Curtin S.C.
        • Matthews T.J.
        Births: Final data for 2012. National vital statistics reports; vol 62.
        National Center for Health Statistics, Hyattsville, MD2012 (Available at:) (Accessed May 1, 2014)
        • American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics
        ACOG Practice bulletin: prediction and prevention of preterm birth, number 130.
        Obstet Gynecol. 2012; 120: 964-973
        • Hassan S.S.
        • Romero R.
        • Vidyadhari D.
        • et al.
        Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial.
        Ultrasound Obstet Gynecol. 2011; 38: 18-31
        • Fonseca E.B.
        • Celik E.
        • Parra M.
        • Singh M.
        • Nicolaides K.H.
        Progesterone and the risk of preterm birth among women with a short cervix.
        N Engl J Med. 2007; 357: 462-469
        • Werner E.F.
        • Han C.S.
        • Pettker C.M.
        • Buhimschi C.S.
        • Copel J.A.
        • Funai E.F.
        Universal cervical-length screening to prevent preterm birth: a cost-effectiveness analysis.
        Ultrasound Obstet Gynecol. 2011; 38: 32-37
        • Cahill A.G.
        • Odibo A.O.
        • Caughey A.B.
        • et al.
        Universal cervical length screening and treatment with vaginal progesterone to prevent preterm birth: a decision and economic analysis.
        Am J Obstet Gynecol. 2010; 202: 548.e1-548.e8
        • Pizzi L.T.
        • Seligman N.S.
        • Baxter J.K.
        • Jutkowitz E.
        • Berghella V.
        Cost and cost effectiveness of vaginal progesterone gel in reducing preterm birth: an economic analysis of the PREGNANT trial.
        Pharmacoeconomics. 2014; 32: 467-478
        • Parry S.
        • Simhan H.
        • Elovitz M.
        • Iams J.
        Universal maternal cervical length screening during the second trimester: pros and cons of a strategy to identify women at risk of spontaneous preterm delivery.
        Am J Obstet Gynecol. 2012; 207: 101-106
        • Morken N.H.
        • Källen K.
        • Jacobsson B.
        Predicting risk of spontaneous preterm delivery in women with a singleton pregnancy.
        Paediatr Perinat Epidemiol. 2014; 28: 11-22
        • Facco F.L.
        • Simhan H.N.
        Short ultrasonographic cervical length in women with low-risk obstetric history.
        Obstet Gynecol. 2013; 122: 858-862
        • Orzechowski K.M.
        • Nicholas S.
        • Baxter J.
        • Weiner S.
        • Berghella V.
        Implementation of a universal cervical length screening program for the prevention of preterm birth.
        Am J Perinatology. 2014; (April 14 [Epub ahead of print])
        • Orzechowski K.M.
        • Boelig R.C.
        • Baxter J.K.
        • Berghella V.B.
        Real world experience from a universal transvaginal cervical length screening program for preterm birth prevention.
        Obstet Gynecol. 2014; 124: 520-525
      1. Cervical Length Education and Review (CLEAR) program [Internet]. Available at: Accessed March 1, 2013.

        • Iams J.D.
        • Goldenberg R.L.
        • Meis P.J.
        • et al.
        The length of the cervix and the risk of spontaneous premature delivery.
        N Engl J Med. 1996; 334: 567-572
        • Iams J.D.
        Clinical practice: prevention of preterm parturition.
        N Engl J Med. 2014; 370: 254-261