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Second trimester cervical length screening, in a low-risk European population
Francesca Ferrari1, Beatrice Melis1, Laura Basile1
1Obstetrics Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
Summary
Universal cervical length screening in low-risk pregnancies is unlikely to prevent preterm birth (PTB) due to the low incidence of short cervix. Most PTB cases occur in women with normal cervical length, making widespread screening ineffective for PTB prevention.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Public Health Screening
Background:
- Preterm birth (PTB) is a significant concern in maternal-fetal medicine.
- Cervical length (CL) screening is explored as a method for PTB prevention.
- Evaluating CL distribution in low-risk populations is crucial for assessing screening applicability.
Purpose of the Study:
- To assess cervical length (CL) distribution in a low-risk pregnant population.
- To evaluate the applicability of universal CL screening in the second trimester for PTB prevention.
- To define CL curves and the incidence of short cervix (CL ≤ 25 mm) in low-risk women.
Main Methods:
- A multicentric, prospective cohort study included singleton pregnancies between 18+0 and 22+6 weeks of gestation.
- Exclusion criteria: teenage pregnancy and history of PTB.
- Transvaginal ultrasound (TVU) CL measurements were performed by expert sonographers across 12 NHS clinics.
Main Results:
- The study screened 3226 women; mean CL was 40.8 mm, median CL was 40 mm.
- The 2nd centile for CL was 25 mm, with an incidence of CL ≤ 25 mm (short cervix) of 1.25%.
- Short cervix (CL ≤ 25 mm) and stature ≤ 150 cm were independent predictors for PTB.
Conclusions:
- Women with short cervix have a higher risk of PTB, but the low incidence means most PTBs occur in women with normal cervical length.
- Universal CL screening in this low-risk Italian population is forecast to be ineffective for PTB prevention.
- Stature ≤ 150 cm was also identified as an independent predictor for PTB.
