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The introduction of a universal transvaginal cervical length screening program is associated with a reduced preterm
Aude Figarella1, Cécile Chau2, Anderson Loundou3
1Department of Gynecology, Obstetrics and Reproductive Medicine, Assistance Publique-Hopitaux de Marseille (AP-HM) Hôpital de la Conception, Pôle femmes parents enfants, Marseille, France; Aix-Marseille University, Marseille, France; Avignon Université, Centre national de la recherche scientifique, Institut de Recherche pour le Développement, Institut Méditerranéen de Biodiversité et d'Ecologie marine et continentale, Marseille, France.
Background:
Midtrimester sonographic short cervix is a good predictor of preterm birth in singleton pregnancies.
Objective:
This study aimed to assess the impact of implementing a universal transvaginal cervical length screening program on preterm birth rate.
Study Design:
This study consisted of 2 parts: a before-and-after multicenter study and a study on the ECHOCOL ("echo"="ultrasound" and "col"="cervix" in French) prospective cohort. We compared the rate of preterm birth before and after the introduction of universal cervical length screening at the time of midtrimester anatomy ultrasound. The multicenter before-and-after regional study included all women with a singleton pregnancy who gave birth after 24 weeks' gestation in the South East of France from January 1, 2012 to April 30, 2018. In parallel, the ECHOCOL cohort study was prospectively conducted from May 2015 to July 2018, including 17 maternity hospitals in the South East region of France. In case of asymptomatic short cervix <25 mm, treatments offered included 200 mg of vaginal progesterone, or cerclage, or a pessary until 34 weeks' gestation.
Results:
We observed a significant decrease rate of preterm birth between periods A and B after multivariate analysis. (respectively, 5.8% vs 5.6%; adjusted odds ratio, 0.92; 95% confidence interval, 0.89-0.95; P<.0001). In parallel, the percentage of cervical length screening significantly increased from 28.9% in period A to 52.9% in period B (odds ratio, 2.76; 95% confidence interval, 2.71-2.80; P<.0001). Among the 3468 patients of the ECHOCOL prospective cohort, 38 (1.1%) asymptomatic short cervices were detected, and 192 patients gave birth prematurely (11 with an asymptomatic short cervix and 181 without). In the ECHOCOL cohort, a marked but statistically insignificant tendency toward a reduced rate of preterm birth before 37 weeks of gestation was observed (from 5.8% to 5.5%; adjusted odds ratio, 0.72; 95% confidence interval, 0.51-1.03; P=.068).
Conclusion:
This study showed a significantly lower rate of preterm birth after the implementation of a universal cervical length screening and treating policy during the second trimester of pregnancy. The clinical trial was registered under NCT02598323.
