Implementation of a universal cervical length screening program: identifying factors associated with decline rates

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Public Health

Background:

• Cervical length (CL) measurement is a validated screening tool for identifying women at risk of preterm birth (PTB).
• Patient acceptability is crucial for the successful implementation of CL screening programs.
• Understanding factors influencing patient decisions to decline screening is essential for optimizing PTB prevention strategies.

Purpose of the Study:

• To identify characteristics of women who decline cervical length (CL) screening.
• To analyze factors associated with the refusal of CL screening as a method for preterm birth (PTB) risk identification.

Main Methods:

• Secondary analysis of a prospective cohort study involving women offered CL screening during their anatomy scan.
• Utilized an "opt-out" approach for offering CL screening to eligible women with singleton gestations.
• Employed Chi-square, Wilcoxon rank sum tests, and logistic regression to analyze factors associated with declining screening.

Main Results:

• Out of 1348 women offered CL screening, 131 (9.7%) declined.
• Multiparous women were more than twice as likely to decline CL screening compared to primiparous women (OR 2.4).
• Patient acceptance rates for CL screening were significantly influenced by the sonographer.

Conclusions:

• Multiparous women demonstrate lower acceptance rates for CL screening as a PTB prevention strategy.
• Variability in acceptance rates among sonographers suggests a need for standardized counseling.
• Implementing standardized counseling approaches may enhance patient acceptance and improve the effectiveness of PTB prevention programs.