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Implementation of a universal cervical length screening program for the prevention of preterm birth
Kelly M Orzechowski1, Sara S Nicholas1, Jason K Baxter1
1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Insights
Universal cervical length (CL) screening is feasible and acceptable for predicting and preventing preterm birth (PTB). Most eligible women accepted CL screening, demonstrating its practicality in clinical settings.
Area of Science:
- Maternal-Fetal Medicine
- Obstetrics
- Public Health
Background:
- Preterm birth (PTB) remains a leading cause of neonatal morbidity and mortality.
- Cervical length (CL) screening via transvaginal ultrasound (TVU) is a key method for predicting PTB.
- Implementing universal CL screening programs is crucial for early detection and intervention.
Purpose of the Study:
- To evaluate the implementation and acceptability of a universal cervical length (CL) screening program.
- To assess the feasibility of integrating CL screening into routine prenatal care for PTB prevention.
- To determine factors influencing women's acceptance of CL screening.
Main Methods:
- Prospective observational study conducted over 12 months.
- Included women with singleton gestations screened between 18 and 23 weeks' gestation.
- Program transitioned from "opt-in" to "opt-out" to assess impact on screening rates.
Main Results:
- 87% of eligible women were offered CL screening, with 75% undergoing the procedure.
- Nulliparous women and those screened by female sonographers were more likely to accept screening.
- The "opt-out" protocol did not significantly increase screening uptake compared to "opt-in".
Conclusions:
- Universal cervical length (CL) screening is a feasible and acceptable intervention for PTB prediction.
- The program demonstrated successful implementation with high acceptability among pregnant women.
- Further strategies may be needed to optimize uptake in all populations.
Objective:
The objective of this article is to evaluate the implementation and acceptability of a universal cervical length (CL) screening program for prediction and prevention of preterm birth (PTB).
Study Design:
We performed a prospective observational study to evaluate the implementation and acceptability of a universal CL screening program. Between January 1, 2012, and December 31, 2012, women with singleton gestations, without a cerclage or prior spontaneous PTB, were offered transvaginal ultrasound (TVU) for CL between 18(0/7) and 23(6/7) weeks' gestation. Sonographers and medical staff received education before implementation. Intervention for a short CL was interpreted according to a standard protocol. On June 1, 2012, our program was modified from "opt-in" to "opt-out." SPSS 20.0 (released 2011, IBM statistics for Windows version 20, IBM Corp., Armonk, NY) was used for analysis.
Results:
Over 12 months, 1,484 (87%) of 1,706 eligible women were offered CL screening, and 1,119 (75%) were actually screened. Women were more likely to accept CL screening if they were nulliparous versus multiparous (83 vs. 68%, p < 0.001) and if the sonographer was female versus male (83 vs. 42%, p < 0.001). Implementation of an "opt-out" protocol did not increase the overall number of women accepting CL screening compared with an "opt-in" approach (76 vs. 75%, p = 0.81) CONCLUSION: Universal CL screening can be feasibly implemented and is acceptable to most women.
