Implementation of a universal cervical length screening program: identifying factors associated with decline rates.
OBJECTIVE
Cervical length (CL) measurement is now accepted as a screening strategy for identifying women at risk for preterm birth (PTB). However, patient acceptability may limit its implementation. Our objective was to identify characteristics associated with women who decline this screening.


METHODS
This is a secondary analysis of a prospective cohort study of women offered UCL screening from January 2012 to June 2012. Women with a singleton gestation 18 0/7-23 6/7 weeks at the time of anatomy scan were included. Trained sonographers were instructed to perform UCL screening on all eligible patients using an "opt-out" approach. Chi square statistics and Wilcoxon rank sum tests were used to compare categorical and continuous data, where appropriate. Logistic regression was used to calculate odds ratio for factors associated with declining UCL screening Results: 1348 women were offered CL screening; 131 (9.7%) declined. Overall, multiparous women were more than twice as likely to decline UCL screening compared to primiparous women [OR 2.4 (1.6-3.8)]. Patient acceptance of screening was significantly dependent on the sonographer (p < .05).


CONCLUSIONS
Multiparous women are less likely to accept this strategy of PTB prevention. A standardized counseling approach may improve patient acceptance and mitigate variability in acceptance rates observed amongst sonographers.
a Maternal-Child Health Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
Jeny
J
Ghartey
a Maternal-Child Health Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
Neda
N
Ghaffari
a Maternal-Child Health Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
Lisa D
LD
Levine
a Maternal-Child Health Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
Nadav
N
Schwartz
a Maternal-Child Health Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
Celeste P
CP
Durnwald
D000328:Adult; D001294:Attitude to Health; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000000981:diagnostic imaging; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D005865:Gestational Age; D006801:Humans; D008403:Mass Screening; D010298:Parity; D011247:Pregnancy; D047928:Premature Birth / Q000175:diagnosis; D011446:Prospective Studies
Universal cervical length; decline rates; implementation