title: Is universal cervical length screening indicated in women with prior term birth?
abstract: OBJECTIVE
  To determine whether universal transvaginal ultrasound (TVU) cervical length (CL) screening is indicated in women with prior term births.
  
  
  METHODS
  We conducted a prospective cohort study from Jan. 1, 2012, to June 30, 2013, of singleton gestations between 18 0/7-23 6/7 weeks undergoing TVU CL screening for prediction of spontaneous preterm birth (sPTB). Women with a prior sPTB, with cerclage, and without delivery data available were excluded. Primary outcomes were the incidence of a CL ≤20 mm, and rates of sPTB <37, <34, and <32 weeks gestation among women with prior term births vs nulliparous women.
  
  
  RESULTS
  A total of 1569 women underwent TVU CL screening; 18 women with a prior iatrogenic preterm birth were excluded. Of those screened, 756 (48.7%) had a prior term delivery and 795 (51.3%) were nulliparous. Women with prior term births differed from nulliparous women with respect to age, body mass index, race, smoking status, and prior dilation and curettage. After adjustment for these confounders, there was no statistical difference in the incidence of CL ≤20 mm (0.8 vs 1.4%; adjusted odds ratio, 0.35; 95% confidence interval, 0.12-1.03) among women with prior term births compared with nulliparous women. Rates of sPTB <37, <34, <32 weeks were similar in women with a prior term birth compared with nulliparous women. The overall incidence of sPTB <37 weeks was 3.2% in women with a prior term birth and 5.0% in nulliparous women. When a CL ≤20 mm was identified, 3 of 6 women with prior term birth delivered at <37 weeks compared with 8 of 11 nulliparous women. There were no identified differences between the odds of sPTB between women with a CL ≤20 mm who had a prior term birth compared with nulliparous women.
  
  
  CONCLUSIONS
  Women with prior term birth have a trend toward a lower incidence of CL ≤20 mm, compared with nulliparous women. Further studies are needed to determine whether women with prior term births should be included or excluded from TVU CL screening.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA. Electronic address: kelly.orzechowski@gmail.com.
authors.forename: Kelly Marie
authors.initials: KM
authors.lastname: Orzechowski
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Rupsa
authors.initials: R
authors.lastname: Boelig
authors.affiliation: Department of Obstetrics and Gynecology, Main Line Perinatal, Wynnewood, PA.
authors.forename: Sara Shaw
authors.initials: SS
authors.lastname: Nicholas
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Jason
authors.initials: J
authors.lastname: Baxter
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D054791:Cervical Length Measurement / Q000379:methods*; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008403:Mass Screening; D010298:Parity; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D018570:Risk Assessment; D047929:Term Birth; D055815:Young Adult
keywords: cervical length; preterm birth; prior term birth; universal screening; vaginal progesterone