Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia.
Department of Ultrasound, King Edward Memorial Hospital, Perth, Western Australia, Australia.
Aust N Z J Obstet Gynaecol. 2022 Oct;62(5):650-657. doi: 10.1111/ajo.13514. Epub 2022 Mar 13.
Routine cervical length (CL) measurement at the mid-pregnancy ultrasound is a central recommendation of the Western Australian Preterm Birth Prevention Initiative (Initiative).
To evaluate the perceptions and changes in practice of Western Australian obstetric care providers regarding routine CL screening for preterm birth (PTB) prevention following the Initiative introduction.
Two self-administered questionnaires were completed by providers from a range of practices. The first was during site visits with the Initiative Outreach team in 2015-2016. The questionnaire was re-issued in 2021 via online dissemination. Participant demographic data and opinions on CL screening for PTB prevention were collected.
Two hundred and fourteen providers participated in 2015-2016 and 109 in 2021. In both surveys, providers were more likely to discuss transvaginal CL screening with high-risk women (48.1%, 76.1%; P < 0.001) compared with low-risk (7.5%, 18.3%; P = 0.002) and the importance of CL screening (13.5%, 40.4%; P < 0.001), in 2015-2016 and 2021, respectively. Responses relating to CL screening, including what constitutes a short cervix on ultrasound were varied. A transabdominal CL <35 mm was classified as short by 46.2% and 37.6% and <25 mm on transvaginal ultrasound by 49.1% and 64.2%, in the respective surveys. Most providers ceased progesterone (68.6%, 75.2%) at >28 weeks gestation.
Providers focused on women with overt PTB risk factors, rather than a universal CL screening approach. Although there was improvement between the surveys, the definition of what constitutes a short cervix on ultrasound and how to treat and monitor women with a short CL remained varied.
在妊娠中期的超声检查中常规测量宫颈长度（CL）是西澳大利亚早产预防计划（Initiative）的核心建议。
评估西澳大利亚产科保健提供者在引入该计划后，对预防早产（PTB）的常规 CL 筛查的看法和实践变化。
通过一系列实践，由提供者自行完成两份调查问卷。第一份是在 2015-2016 年与 Initiative 外展团队进行的现场访问中完成的。2021 年，通过在线传播重新发布了问卷。收集参与者的人口统计学数据和对 CL 筛查预防 PTB 的意见。
2015-2016 年有 214 名提供者参与，2021 年有 109 名提供者参与。在这两项调查中，与低风险（7.5%，18.3%；P=0.002）相比，提供者更有可能与高风险女性（48.1%，76.1%；P<0.001）讨论经阴道 CL 筛查，2015-2016 年和 2021 年分别为重要性（13.5%，40.4%；P<0.001）。关于 CL 筛查的回答，包括超声上的短颈定义各不相同。46.2%和 37.6%的人认为经腹 CL <35mm 短，49.1%和 64.2%的人认为经阴道超声 <25mm 短。大多数提供者在妊娠 28 周以上停止使用孕激素（68.6%，75.2%）。
提供者专注于有明显 PTB 危险因素的女性，而不是采用通用的 CL 筛查方法。尽管两次调查之间有所改善，但超声上的短颈定义以及如何治疗和监测短颈的女性仍存在差异。
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