Temming Lorene A, Durst Jennifer K, Tuuli Methodius G, Stout Molly J, Dicke Jeffrey M, Macones George A, Cahill Alison G
Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO.
Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO.
Am J Obstet Gynecol. 2016 Apr;214(4):523.e1-523.e8. doi: 10.1016/j.ajog.2016.02.002. Epub 2016 Feb 10.
Transvaginal measurement of cervical length (CL) has been advocated as a screening tool to prevent preterm birth, but controversy remains regarding the overall utility of universal screening.
We aimed to evaluate the acceptability of a universal CL screening program. Additionally we evaluated risk factors associated with declining screening and subsequent delivery outcomes of women who accepted or declined screening.
This was a retrospective cohort study of transvaginal CL screening at a single institution from July 1, 2011, through December 31, 2014. Institutional protocol recommended transvaginal CL measurement at the time of anatomic survey between 17-23 weeks in all women with singleton, viable pregnancies, without current or planned cerclage, with patients able to opt out. Patients with CL ≤20 mm were considered to have clinically significant cervical shortening and were offered treatment. We assessed acceptance rate, risk factors for declining CL screening, and the trend of acceptance of CL screening over time. We also calculated the prevalence of CL ≤25, ≤20, and ≤15 mm, and estimated the association between CL screening and spontaneous preterm birth.
Of 12,740 women undergoing anatomic survey during the study period, 10,871 (85.3%; 95% confidence interval [CI], 84.7-85.9%) underwent CL screening. Of those, 215 (2.0%) had a CL ≤25 mm and 131 (1.2%) had a CL ≤20 mm. After the first 6 months of implementation, there was no change in rates of acceptance of CL screening over time (P for trend = .15). Women were more likely to decline CL screening if they were African American (adjusted odds ratio [aOR], 2.17; 95% CI, 1.93-2.44), obese (aOR, 1.18; 95% CI, 1.06-1.31), multiparous (aOR, 1.45; 95% CI, 1.29-1.64), age <35 years (aOR, 1.24; 95% CI, 1.08-1.43), or smokers (aOR, 1.42; 95% CI, 1.20-1.68). Rates of spontaneous preterm birth <28 weeks were higher in those who declined CL screening (aOR, 2.01; 95% CI, 1.33-3.02).
Universal CL screening was implemented successfully with 85% of women screened. Overall incidence of short cervix was low and women with significant risk factors for preterm birth were more likely to decline screening. Patients who declined CL screening were more likely to be African American, obese, multiparous, age <35 years, and smokers. Rates of early, but not late, spontaneous preterm birth were significantly higher among women who did not undergo CL screening.
经阴道测量宫颈长度（CL）已被提倡作为预防早产的筛查工具，但关于普遍筛查的整体效用仍存在争议。
我们旨在评估普遍CL筛查项目的可接受性。此外，我们评估了与筛查拒绝相关的风险因素以及接受或拒绝筛查的女性的后续分娩结局。
这是一项对2011年7月1日至2014年12月31日期间在单一机构进行的经阴道CL筛查的回顾性队列研究。机构方案建议在所有单胎、存活妊娠、无当前或计划宫颈环扎且患者可选择退出的女性在17至23周进行解剖学检查时测量经阴道CL。CL≤20mm的患者被认为有临床上显著的宫颈缩短并接受治疗。我们评估了接受率、CL筛查拒绝的风险因素以及CL筛查随时间的接受趋势。我们还计算了CL≤25mm、≤20mm和≤15mm的患病率，并估计了CL筛查与自发性早产之间的关联。
在研究期间接受解剖学检查的12740名女性中，10871名（85.3%；95%置信区间[CI]，84.7 - 85.9%）接受了CL筛查。其中，215名（2.0%）CL≤25mm，131名（1.2%）CL≤20mm。在实施的前6个月后，CL筛查的接受率随时间没有变化（趋势P值 = 0.15）。非裔美国女性（调整优势比[aOR]，2.17；95%CI，1.93 - 2.44）、肥胖女性（aOR，1.18；95%CI，1.06 - 1.
