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Objective-To estimate which strategy is the most cost-effective for prevention of preterm birth and associated morbidity.Study Design-We used decision-analytic and cost-effectiveness analyses to estimate which of 4 strategies was superior based on quality-adjusted life-years (QALYs), cost in US dollars ($), and number of preterm births prevented.Results-Universal sonographic screening for cervical length and treatment with vaginal progesterone was the most cost-effective strategy and dominant over 3 alternatives: cervical length screening for women at increased risk for preterm birth and treatment with vaginal progesterone; risk-based treatment with 17 α-hydroxyprogesterone Caproate (17-OHP-C) without screening; no screening or treatment. Universal screening represented savings of $1,339 ($8,325 vs. $9,664) when compared to treatment with 17-OHP-C, and led to a reduction of 95,920 preterm births annually in the US. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Financial disclosures:We wish to disclose to the Editors that after the submission of the manuscript, Dr. Macones now serves on an Advisory Board for TherRx, the company that has the rights to 17-OHP-C if it is FDA approved. Conclusion-Universal sonographic screening for short cervical length and treatment with vaginal progesterone appears cost-effective and yields the greatest reduction in preterm birth prior to 34 weeks.

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The institutional fetal loss rate attributable to amniocentesis is 0.13%, or 1 in 769 at Washington University School of Medicine. The total fetal loss rate was not significantly different from that observed in patients who had no procedure.