Exploring perspectives on implementing cervical length screening to prevent preterm birth in nulliparous women:...

Preterm birth risk prediction currently relies on previous history, with those classified as intermediate-risk or high-risk being offered cervical length measurements. However, most preterm births occur in women considered low-risk. The majority of low-risk women are first-time mothers (nulliparous women) and therefore, typically do not receive cervical length measurements. Evidence from outside the UK suggests that cervical length screening and treatment with progesterone in low-risk women can prevent preterm birth. However, little is known about the acceptability and feasibility of introducing cervical length screening in low-risk nulliparous women in the UK National Health Service (NHS). This study aims to provide this evidence to inform decision-making for cervical length screening (NIHR PGfAR 207290).

A study consisting of two theoretically informed qualitative work packages will explore the perspectives and experiences of women, healthcare professionals and other relevant stakeholders regarding cervical length screening for low-risk nulliparous women. Data will be collected through a combination of semistructured interviews and focus groups with approximately 50 healthcare professionals and 50 women and an online survey.Women will be purposively sampled from community groups and maternity units. Healthcare professionals and providers will be identified through purposive and snowball sampling from maternity units and healthcare and other relevant organisations including those involved in the planning and commissioning of antenatal services. All interviews and focus groups will be audio-recorded and transcribed verbatim. Posters advertising the study will be displayed in maternity units and community centres. Data collection began in September 2025 and is due to end in December 2026. Data will first be analysed inductively and then deductively using the Behaviour Change Wheel, Theoretical Domains Framework and the Feasibility Framework.

Ethical approval was granted by the Health Research Authority (IRAS 349196) and NHS Research Ethics Committee (25/NW/0252) as well as the University of Birmingham (RG_25-018). Findings will be shared with service users and healthcare providers through peer-reviewed publications and conferences. Results will also be reported to the UK National Screening Committee to inform recommendations on national adoption.