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Am J Perinatol 2024; 41(07): 859-866
DOI: 10.1055/s-0042-1748156
Original Article

Cervical Length Ultrasound for the Evaluation of Preterm Labor: A Survey of National Use and Review of Evidence

Rupsa C. Boelig 
1   Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
,
Jennifer Mcintosh 
2   Division of Maternal-Fetal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Helen Feltovich
3   Women's Department, Maternal-Fetal Medicine Division, Intermountain Healthcare, Salt Lake City Utah
,
Michael House
4   Division of Maternal-Fetal Medicine, Tufts Medical Center, Boston, Massachusetts
› Author Affiliations Funding R.C.B. was supported by a PhRMA Foundation Faculty Development Award.
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Abstract

Objective The objective of this study was to survey national utilization of cervical length (CL) ultrasound on labor and delivery (L&D) for the evaluation of preterm labor (PTL) and identify provider attitudes and barriers to utilization.

Study Design Survey was emailed to Obstetrics and Gynecology Residency and Maternal-Fetal Medicine Fellowship program and advertised via links on obstetric-related Facebook interest groups. The survey was open from August 4, 2020 to January 4, 2021. Characteristics between respondents who did and did not report the use of CL ultrasound for PTL evaluation were compared with chi-square analysis.

Results There were 214 respondents across 42 states. One hundred and thirty-four respondents (63%) reported any use of CL in the evaluation of PTL and eighty (37%) denied it. There was a significant difference in practice location, practice type, delivery volume, and region between those who did and did not utilize CL ultrasound on L&D. Those who did use CL ultrasound were more likely to report no barriers to use (40 vs. 4%, p < 0.001). The most common barriers involved the availability of transvaginal ultrasound (31%), sterilization of transvaginal ultrasound probe (32%), limited availability of persons able to perform/interpret CL imaging (38%). Nineteen percent believed CL ultrasound had little/no utility in clinical practice. Those who did not use CL ultrasound in the evaluation of PTL were significantly more likely to report the feeling that there was little/no utility of CL ultrasound in clinical practice (37 vs. 7%, p < 0.001) and to report transvaginal ultrasound availability as barriers to use (63 vs. 12%, p < 0.001).

Conclusion CL ultrasound is used nationally in PTL evaluation. However, significant barriers limit widespread adoption. These barriers can be addressed through the dissemination of information and practice guidelines, addition of CL ultrasound education in residency training and through CME opportunities after training, and providing support/resources/access for those looking to add this tool to their practice environment.

Key Points

  • In a national survey, 63% of obstetricians endorsed any use of cervical length (CL) ultrasound for preterm labor evaluation on labor and delivery.

  • The most common barriers involved the availability of transvaginal ultrasound (31%), sterilization of transvaginal ultrasound probe (32%), limited availability of persons able to perform/interpret CL imaging (38%).

  • Those who did not use CL ultrasound in the evaluation of PTL were significantly more likely to report the feeling that there was little/no utility of CL ultrasound in clinical practice and to report transvaginal ultrasound availability as barriers to utilization.

  • Barriers to utilization of CL ultrasound for preterm labor evaluation can be addressed through practice guidelines, ultrasound education, and support for equipment/training necessary for use.

Keywords

Cervical Length - preterm labor - preterm birth - research - cervical length ultrasound

Note

This publication was supported by the Perinatal Quality Foundation, a non-profit organization that provides the certification of cervical length imaging in pregnancy (clear.perinatalquality.org). The authors are volunteers for the Perinatal Quality Foundation.


Supplementary Material



Publication History

Received: 04 May 2021

Accepted: 18 February 2022

Article published online:
17 May 2022

© 2022. Thieme. All rights reserved.

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