Is universal cervical length screening indicated in women with prior term birth?

• Published in: American journal of obstetrics and gynecology Vol. 212; no. 2; pp. 234.e1 - 234.e5
• Main Authors: Orzechowski, Kelly Marie, MD, MPH, Boelig, Rupsa, MD, Nicholas, Sara Shaw, MD, Baxter, Jason, MD, MSCP, Berghella, Vincenzo, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2015
• Subjects: Adult; Case-Control Studies; cervical length; Cervical Length Measurement - methods; Cervix Uteri - diagnostic imaging; Female; Humans; Mass Screening; Obstetrics and Gynecology; Parity; Pregnancy; Pregnancy Trimester, Second; Premature Birth - diagnostic imaging; preterm birth; prior term birth; Prospective Studies; Risk Assessment; Term Birth; universal screening; vaginal progesterone; Young Adult; preterm birth; vaginal progesterone; prior term birth; universal screening; cervical length
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2014.08.029

Objective To determine whether universal transvaginal ultrasound (TVU) cervical length (CL) screening is indicated in women with prior term births. Study Design 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. Conclusion 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.