Περίληψη:
Objective To assess the feasibility and results of introducing a policy
of universal screening for preterm delivery (PTD) by mid-trimester
cervical-length (CL) measurement.
Methods In this retrospective cross-sectional study of singleton
pregnancies, transvaginal sonography for CL measurement was performed at
20-24 weeks of gestation. Vaginal progesterone therapy was offered to
women with CL <= 15 mm. The incidence of spontaneous PTD (sPTD)
according to CL and the distribution of CL measurements were assessed.
Rate of PTD before implementation of screening was compared with that
after.
Results A total of 10 506 singleton pregnancies were assessed. The
decline rate was 1.32%. sPTD < 32 weeks, < 34 weeks and< 37 weeks
occurred in 0.51%, 0.82% and 3.90% of pregnancies, respectively. CL
measurement was best described by a mixture model distribution
comprising a ‘short’ and a ‘long’ component. The percentage of the two
components varied between subgroups of PTD, with the short component
being greater the earlier the birth. CL, history of miscarriage, smoking
status and prior PTD were independent predictors in the construction of
a model predictive of PTD< 34 weeks (area under the curve = 0.74, P <
0.001). The rate of sPTD < 34 weeks in women with CL= 15mm receiving
progesterone treatment was 20.4%. In the progesterone-treated group, a
plateau was observed in the increase in risk for PTD for CL 9-13 mm,
whereas below 9mm the risk increased exponentially. Following the
introduction of mid-trimester CL measurement, there was a trend for
reduction in the rate of any PTD< 34 weeks of about 20% in comparison
with the prescreening period (odds ratio= 0.81; 95% CI, 0.59-1.13).
Conclusions Universal screening for PTD by transvaginal sonographic
measurement of CL at 20-24weeks is feasible and well accepted by
pregnant women. This policy identifies a very high-risk group that may
benefit from intervention. Copyright (c) 2018 ISUOG. Published by John
Wiley & Sons Ltd.
Συγγραφείς:
Souka, A. P.
Papastefanou, I.
Pilalis, A.
Kassanos, D. and
Papadopoulos, G.
