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Variation between countries for routine transvaginal cervical length measurement and interventions to prevent preterm
E V J van Limburg Stirum1, N Pilarski2, M A de Boer1
1Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, De Boelelaan 1117, Amsterdam, Netherlands (the); Amsterdam Reproduction & Development, Amsterdam, Netherlands (the).
European Journal of Obstetrics, Gynecology, and Reproductive Biology
|November 7, 2024
Summary
Significant international variations exist in how healthcare providers measure cervical length and offer interventions to prevent preterm birth (PTB). A standardized approach is needed to manage high-risk pregnancies effectively.
Area of Science:
- Maternal-Fetal Medicine
- Obstetrics
- Reproductive Health
Background:
- Preterm birth (PTB) remains a leading cause of neonatal mortality and morbidity worldwide.
- Current management strategies for preventing PTB, particularly those involving cervical length assessment and interventions, show considerable heterogeneity.
- Standardization of care is crucial for improving outcomes in high-risk pregnancies.
Purpose of the Study:
- To evaluate the international variability in the routine transvaginal ultrasound assessment of cervical length.
- To investigate the differences in interventions offered for the prevention of preterm birth (PTB) across various countries.
- To identify areas for potential standardization in PTB prevention protocols.
Main Methods:
- An anonymous digital questionnaire was distributed to delegates of the European Spontaneous Preterm Birth Congress (August-October 2023).
- The survey assessed the method, indications, timing, and frequency of cervical length measurements.
- It also collected data on interventions (e.g., progesterone, cerclage) and activity advice for women at risk of PTB.
Main Results:
- Responses from 103 participants across 15 countries revealed significant variations in cervical length measurement techniques and timing.
- While vaginal progesterone is widely used (96%), dosages and the timing/gestational age for cerclage placement differ substantially.
- Routine first-trimester cervical length screening is uncommon, but serial measurements are initiated in the first or second trimester for women with a history of PTB.
Conclusions:
- Substantial inter- and intra-country variations exist in the indications, timing, and methods for cervical length assessment and PTB prevention interventions.
- There is a clear need for a more unified, evidence-based approach to managing patients at risk for preterm birth.
- Standardizing protocols can lead to more consistent and effective care for preventing PTB.
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