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 <25 mm, 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, 0.89–0.95; 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, 2.71–2.80; 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, 0.51–1.03; P=.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.

中文翻译：

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通用经阴道宫颈长度筛查计划的引入与早产率降低有关

背景

孕中期超声短宫颈是单胎妊娠早产的良好预测指标。

客观的

本研究旨在评估实施普遍的经阴道宫颈长度筛查计划对早产率的影响。

学习规划

本研究由两部分组成：多中心前后对比研究和 ECHOCOL（法语中“echo”=“ultrasound”和“col”=“cervix”）前瞻性队列研究。我们比较了在进行中期解剖超声时引入普遍宫颈长度筛查前后的早产率。这项多中心前后区域研究纳入了 2012 年 1 月 1 日至 2018 年 4 月 30 日期间在法国东南部妊娠 24 周后分娩的所有单胎妊娠妇女。同时，ECHOCOL 队列研究是前瞻性的于 2015 年 5 月至 2018 年 7 月进行，包括法国东南部地区的 17 家妇产医院。在无症状的短子宫颈 <25 毫米的情况下，提供的治疗包括 200 毫克阴道黄体酮，或环扎术，或子宫托直至妊娠 34 周。

结果

经过多变量分析，我们观察到 A 期和 B 期之间的早产率显着降低。（分别为 5.8% 和 5.6%；调整后的比值比，0.92；95% 置信区间，0.89–0.95；P <.0001）。与此同时，宫颈长度筛查的百分比从 A 期的 28.9% 显着增加到 B 期的 52.9%（比值比，2.76；95% 置信区间，2.71–2.80；P<.0001). 在 ECHOCOL 前瞻性队列的 3468 名患者中，检测到 38 名 (1.1%) 无症状短宫颈，192 名患者早产（11 名无症状短宫颈，181 名无）。在 ECHOCOL 队列中，观察到妊娠 37 周前早产率显着但统计学上不显着的降低趋势（从 5.8% 到 5.5%；调整后的比值比，0.72；95% 置信区间，0.51–1.03；P = .068).

结论

这项研究表明，在妊娠中期实施普遍的宫颈长度筛查和治疗政策后，早产率显着降低。临床试验注册号为 NCT02598323。