The Effect of a Universal Cervical Length Screening Program on Antepartum Management and Birth Outcomes.
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.
Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Scott A
SA
Shainker
Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Anna M
AM
Modest
Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Michele R
MR
Hacker
Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Steven J
SJ
Ralston
antepartum interventions; birth outcomes; cervical length; preterm birth; screening program