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There are conflicting reports regarding the utility of universal cervical length screening in a population at low risk for preterm birth. Our objective was to compare the rates of spontaneous preterm birth in singleton pregnancies prior to and after implementation of a universal transvaginal cervical length (uTVCL) screening program in our overall low-risk population.
This retrospective cohort study included women with a singleton gestation who experienced spontaneous preterm delivery (sPTB) at a single tertiary referral center from January 2013 through May 2016. Universal TVCL was implemented by our institution in October of 2014. Women with a cervical length ≤ 25mm were offered treatment. Cases of sPTB were identified by review of labor and delivery birth logs followed by individual chart review to ensure that delivery was due to spontaneous labor or PPROM. Women with no prenatal care or prenatal care outside our institution were excluded. We compared the rates of sPTB at <28, <34 and <37 weeks prior to and after universal TVCL screening. Non-parametric statistics were used for analysis.
Of the 13,447 deliveries occurring within the study period, 13,396 received screening ultrasound by our group and were eligible for inclusion. A minority of women had experienced a prior sPTB (0.7% and 0.5% before and after uTVCL, respectively; p=NS). Patient acceptance of TVCL was 93% in the first year of the program. This increased to 99.2% in 2016. Among women undergoing uTVCL, 114 (1.7%) were diagnosed with cervical shortening. The overall sPTB rate significantly decreased from 3.8% to 2.4% (p= <0.001). A significant reduction of sPTB was also noted at <28 (0.3% vs 0.1%; p=0.04), <34 (1% vs 0.5%; p= <0.001), and <37 weeks (2.5% vs 1.8%; p=0.004). There were no significant differences in maternal age, ethnicity or BMI between the groups.
In our low-risk population, implementation of universal cervical length screening was associated with a significantly reduced rate of both early and late spontaneous preterm delivery.