The introduction of a universal transvaginal cervical length screening program is associated with a reduced preterm birth rate
Résumé
BACKGROUND: Midtrimester sonographic short cervix is a good
predictor of preterm birth in singleton pregnancies.
OBJECTIVE: This study aimed to assess the impact of implementing a
universal transvaginal cervical length screening program on preterm birth
rate.
STUDY DESIGN: This study consisted of 2 parts: a before-and-after
multicenter study and a study on the ECHOCOL (“echo”=“ultrasound” and
“col”=“cervix” in French) prospective cohort. We compared the rate of
preterm birth before and after the introduction of universal cervical length
screening at the time of midtrimester anatomy ultrasound. The multicenter
before-and-after regional study included all women with a singleton pregnancy
who gave birth after 24 weeks’ gestation in the South East of France
from January 1, 2012 to April 30, 2018. In parallel, the ECHOCOL cohort
study was prospectively conducted from May 2015 to July 2018, including
17 maternity hospitals in the South East region of France. In case of
asymptomatic short cervix<25mm, treatments offered included 200 mg of
vaginal progesterone, or cerclage, or a pessary until 34 weeks’ gestation.
RESULTS: We observed a significant decrease rate of preterm birth
between periods A and B after multivariate analysis. (respectively, 5.8% vs
5.6%; adjusted odds ratio, 0.92; 95% confidence interval, 0.89e0.95;
P<.0001). In parallel, the percentage of cervical length screening
significantly increased from 28.9% in period A to 52.9% in period B (odds
ratio, 2.76; 95% confidence interval, 2.71e2.80; P<.0001). Among the
3468 patients of the ECHOCOL prospective cohort, 38 (1.1%) asymptomatic
short cervices were detected, and 192 patients gave birth prematurely
(11 with an asymptomatic short cervix and 181 without). In the
ECHOCOL cohort, a marked but statistically insignificant tendency toward
a reduced rate of preterm birth before 37 weeks of gestation was observed
(from 5.8% to 5.5%; adjusted odds ratio, 0.72; 95% confidence interval,
0.51e1.03; P¼.068).
CONCLUSION: This study showed a significantly lower rate of preterm
birth after the implementation of a universal cervical length screening and
treating policy during the second trimester of pregnancy. The clinical trial
was registered under NCT02598323.
Origine | Fichiers produits par l'(les) auteur(s) |
---|