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Cervical length (CL) measurement is advocated as a screening tool to prevent preterm birth (PTB). Recent data has shown disparities in the acceptance of cervical length screening, with black women, who have an underlying higher risk for PTB, being more likely to decline cervical length screening. We investigated the impact of education prior to midtrimester anatomic survey on uptake of CL screening.
This was a prospective pre-intervention (January 1, 2015-December 31, 2015) and post-intervention (June 1, 2016-May 31, 2017) study at a single institution. The intervention was a brief written and verbal educational session for all patients prior to the mid-trimester anatomy ultrasound. Institutional protocol recommends universal transvaginal CL with patients able to opt-out. All patients eligible for CL screening were included. The primary outcome was the proportion of women declining CL screening. We compared rates of declining CL screening in the period before the educational intervention and the period after the intervention was implemented, stratified by race/ethnicity based on self-report. Univariable and multivariable statistics were used.
Of 8,277 women, 4121 (49.8%) were eligible for CL screening before and 4,156 (50.2%) were eligible after the intervention. Women in the two groups had similar baseline characteristics except that women in the post-intervention period were older and less likely to have a history of PTB. The proportion of women declining CL screening was significantly lower in the time period after the educational intervention was implemented among all participants (12.2% before vs 8.4% after, aRR 0.65, 95% CI 0.60, 0.78) (Table). The intervention was associated with a significant decrease in declining CL screening among both black (14.1% vs 8.1%, aRR 0.57, 95% CI 0.45, 0.71) and non-blacks (11.3% vs 8.5%, aRR 0.75, 95% CI 0.64, 0.88). There was evidence of interaction by race/ethnicity (P for interaction=0.044), suggesting that the effect was significantly higher among black women. (Table)
A targeted educational session prior to midtrimester ultrasound increased the uptake of CL screening and reduced the disparity in uptake of screening between black women and non-black women.