Is routine transvaginal cervical length measurement cost-effective in a population where the risk of spontaneous preterm birth is low?
BACKGROUND
A recent meta-analysis has suggested that routine measurement of the cervical length should be performed in conjunction with the anomaly scan to identify a group of women at increased risk of preterm delivery. We decided to investigate whether this recommendation is justifiable in a population where the risk of preterm birth is low.


METHODS
We reviewed 12 years of obstetric data from the Coombe Women and Infants University Hospital. Relative risks of adverse outcomes from the randomized controlled trial were applied and we extrapolated the possible numbers of women requiring intervention. We then used published neonatal data to estimate the cost of neonatal care and estimated the costs of providing the service.


RESULTS
Over 12 years from 2000 until 2011, there were 94 646 singleton deliveries, 1776 happening before 34 weeks. Spontaneous onset occurred in 882 (49.7%) of this group. These 882 births were studied. If we apply the figures from a randomized controlled trial, 1609 women (1.7% from our total population) would be expected to have a cervical length 15 mm. If we gave vaginal progesterone to all women with a sonographically short cervix, we would reduce the delivery rate before 34 weeks by 27.7%. The annual costs of providing the service were estimated to be €109 249 and the cost of immediate neonatal care was estimated to be €380 514.


CONCLUSIONS
Given the implications associated with preterm delivery, routine measurement of cervical length at the time of the anomaly scan may be justifiable from a cost point of view in a population where the risk of preterm birth is low.
Department of Obstetrics and Gynecology, Coombe Women and Infants University Hospital, Dublin, Ireland.
David A
DA
Crosby
Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland.|Institute for the Care of Mother and Child, Prague, Czech Republic.|UCD School of Medicine, Dublin, Ireland.|3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
Jan
J
Miletin
Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland.|Institute for the Care of Mother and Child, Prague, Czech Republic.
Jana
J
Semberova
Department of Obstetrics and Gynecology, Coombe Women and Infants University Hospital, Dublin, Ireland.|School of Medicine, Trinity College, Dublin, Ireland.
Sean
S
Daly
D000328:Adult; D054791:Cervical Length Measurement / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007494:Ireland; D008297:Male; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics* / Q000209:etiology / Q000517:prevention & control; D012306:Risk; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging* / Q000191:economics
Cervix uteri; delivery; morbidity; neonatal; neonatal mortality; obstetric; premature birth