Consistency in the transabdominal ultrasound measurement of cervical length in mid‐pregnancy

ObjectivesThe objective of our study is to examine cervical length measurements, identification of short cervix, vaginal progesterone use, and rate of spontaneous preterm delivery before and after departmental transition to a universal transvaginal ultrasound screening protocol from a universal transabdominal screening protocol.MethodsThis is a retrospective observational pre–post study examining the year prior to and year following a transition to a universal transvaginal ultrasound screening protocol to assess cervical length at the time of the anatomy survey. Prior to this transition, universal transabdominal cervical length screening was performed, with reflex transvaginal ultrasound measurement if transabdominal measurement was <35 mm or was unable to be obtained.ResultsA total of 1760 charts were reviewed; 962 charts were from the pre‐transition/transabdominal year and 798 charts were from the post‐transition/transvaginal year. In the post‐transition/transvaginal year, cervical length less than 20 mm was identified in 1.5% of cases, compared to 0.7% of cases in the pre‐transition/transabdominal year (p = 0.114). There was no difference in the rate of spontaneous preterm delivery between the two groups (5.1% in the pre‐transition/transabdominal year vs. 6.9% in the post‐transition/transvaginal year; p = 0.111).ConclusionsIn this pre‐post study, introduction of a universal transvaginal cervical length screening did not decrease spontaneous preterm delivery rates or detection of short cervix <20 mm, compared to a protocol of universal transabdominal cervical length screening with reflex to transvaginal for measurement <35 mm.

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Routine transabdominal cervical length screening in mid‐pregnancy for the prevention of preterm birth: Is it good enough to use as a screening test?

Pedretti,

Dickinson,

Doherty

et al. 2024

Aust NZ J Obst Gynaeco

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BackgroundPreterm birth (PTB) is a major pregnancy complication. There is evidence that a short cervical length in mid‐pregnancy may predict women at increased risk of PTB.AimsTo evaluate the utility of population‐based, transabdominal cervical length (TACL) measurement screening in mid‐pregnancy for PTB prediction in women.Materials and MethodsA transabdominal approach was initially performed, with a transvaginal (TVCL) approach offered when the TACL was <35 mm, could not be accurately measured, or the pregnancy had risk factors for PTB. TACL was compared to the directly related TVCL, when both were performed at the same assessment. Women with risk factors of PTB were included when they had both TACL and TVCL measurements performed at the same visit.ResultsData were provided for 9355 singleton pregnancies from 13 participating imaging centres. A transabdominal approach was used in 9006 (96.3%), including 682 (7.3%) TVCL combined with TACL. There were 349 (3.7%) women who had TVCL only. The median TACL was longer (40 mm) than the TVCL (38 mm). In 682 paired TACL and TVCL measurements, TACL <35 mm correctly identified 96.2% of pregnancies with TVCL <25 mm, compared with 65.4% of cases when using a TACL <30 mm. A TVCL <25 mm occurred in 59 (0.6%) women. A TACL <35 mm was associated with birth <37 weeks of gestation in 12.1% of women and birth <32 weeks of gestation in 3.9%.ConclusionsUniversal TACL is a feasible option for population screening of cervical length in a low‐risk population, progressing to TVCL if the TACL is <35 mm or the cervix cannot be transabdominally accurately measured.

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Consistency in the transabdominal ultrasound measurement of cervical length in mid‐pregnancy

Cited by 3 publications

References 31 publications

Ultrasound research – Sometimes you win, sometimes you lose

Ultrasound research – Sometimes you win, sometimes you lose

Introduction of universal transvaginal cervical length measurement does not decrease spontaneous preterm delivery rate compared to universal transabdominal screening with reflex cut‐off: A pre‐post study

Routine transabdominal cervical length screening in mid‐pregnancy for the prevention of preterm birth: Is it good enough to use as a screening test?

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