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AJP Rep 2016; 06(02): e206-e211
DOI: 10.1055/s-0036-1584240
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of a Universal Cervical Length Screening Program on Antepartum Management and Birth Outcomes

Scott A. Shainker
1   Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Anna M. Modest
1   Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
3   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Michele R. Hacker
1   Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
3   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
Steven J. Ralston
1   Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
› Author Affiliations
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Publication History

19 February 2016

11 April 2016

Publication Date:
07 June 2016 (online)

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Abstract

Objective The objective of this study was to evaluate the effect of a universal cervical length screening program on the incidence of antepartum interventions.

Study Design This retrospective cohort study included women delivering ≥ 20 weeks of gestation with singleton pregnancies before and after implementing universal cervical length screening. Antepartum interventions included admission for threatened preterm birth, ≥ 2 cervical length measurements, cervical cerclage, neonatology consultation, betamethasone, antibiotic administration for preterm premature rupture of membranes, and tocolysis.

Results There were 1,131 women—506 before the screening program (unexposed) and 625 afterward (exposed). The screening program resulted in significantly more women screened (3.0 vs. 69.9%, p < 0.0001). The exposed group was more likely to undergo ≥ 1 intervention (20.0 vs. 9.5%, p < 0.0001); specifically, admission for threatened preterm birth (3.8 vs. 1.8%, p = 0.04) and ≥ 2 cervical measurements (11.2 vs. 2.0%, p < 0.001). Other interventions were similar between groups (all p ≥ 0.06). Median gestation length was significantly longer in the exposed (39.6 weeks [interquartile, IQR: 38.6–40.4] vs. 39.0 weeks [IQR: 38.0–40.0, p < 0.001]); however, preterm delivery incidence was unaffected (9.4 vs. 10.9%, p = 0.43). Remaining neonatal outcomes were similar (all p ≥ 0.14).

Conclusion Implementing universal cervical length screening significantly increased the proportion of women undergoing ≥ 1 antepartum intervention. With the exception of a modestly prolonged gestation, other outcomes were unaffected.

Keywords

cervical length - preterm birth - antepartum interventions - screening program - birth outcomes

Note

This work was presented at the 2015 annual meeting of the New England Perinatal Society, Newport, RI, March 13–15, 2015.


 

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