Is universal cervical length screening indicated in women with prior term birth

Objective To determine whether universal transvaginal ultrasound (TVU) cervical length (CL) screening is indicated in women with prior term births. Study Design We conducted a prospective cohort study from Jan. 1, 2012, to June 30, 2013, of singleton gestations between 18 0/7-23 6/7 weeks undergoing TVU CL screening for prediction of spontaneous preterm birth (sPTB). Women with a prior sPTB, with cerclage, and without delivery data available were excluded. Primary outcomes were the incidence of a CL ≤20 mm, and rates of sPTB Results A total of 1569 women underwent TVU CL screening; 18 women with a prior iatrogenic preterm birth were excluded. Of those screened, 756 (48.7%) had a prior term delivery and 795 (51.3%) were nulliparous. Women with prior term births differed from nulliparous women with respect to age, body mass index, race, smoking status, and prior dilation and curettage. After adjustment for these confounders, there was no statistical difference in the incidence of CL ≤20 mm (0.8 vs 1.4%; adjusted odds ratio, 0.35; 95% confidence interval, 0.12–1.03) among women with prior term births compared with nulliparous women. Rates of sPTB Conclusion Women with prior term birth have a trend toward a lower incidence of CL ≤20 mm, compared with nulliparous women. Further studies are needed to determine whether women with prior term births should be included or excluded from TVU CL screening.