title: Implementing universal cervical length screening in asymptomatic women with singleton pregnancies: challenges and opportunities.
abstract: Cervical length (CL) screening has been successfully utilised to identify asymptomatic women, with a singleton pregnancy, at risk of preterm birth (PTB), thereby providing an opportunity to offer interventions that may reduce that risk. Cervical length screening with ultrasound is most effectively performed with a transvaginal approach. Universal cervical length screening, encompassing all singleton pregnancies rather than restricting screening to those considered at increased risk of PTB, is currently not widely used, despite a growing body of evidence in support of its utility for PTB prevention. There are a number of barriers that may prevent or restrict the implementation of a universal CL screening program. These include cost, availability of vaginal progesterone and other treatment options, reluctance of women to undergo transvaginal ultrasound and the perceptions and beliefs of medical practitioners. Given that mid-pregnancy CL measurement is a recognised predictor of spontaneous PTB, that most cases of PTB occur with no prior maternal history and that there are interventions available that may reduce the risk of PTB, we believe there is a clear role for routine CL screening to be adopted as a component of the fetal morphology ultrasound examination. As a strategy to reduce PTB rates, discussion and counselling about PTB prevention and CL screening should be adopted as a core element of prenatal care.
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Michelle K
authors.initials: MK
authors.lastname: Pedretti
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Kazemier
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Jan E
authors.identifier: http://orcid.org/0000-0003-3928-3290
authors.initials: JE
authors.lastname: Dickinson
authors.affiliation: The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia.|The South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D058070:Asymptomatic Diseases; D001291:Attitude of Health Personnel; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D037001:Directive Counseling; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008403:Mass Screening / Q000191:economics; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D011295:Prenatal Care
keywords: cervical length; preterm birth; screening; vaginal progesterone