Authors: M Terrani, F Gonzales, B Petrikovsky, A Dillon
Institutions: Ocean Perinatology, Wyckoff Heights Medical Center
Prematurity remains a major contributor to perinatal morbidity and mortality. In 2007 the Institute of Medicine reported that the annual costs associated with preterm births exceed $26 billion. In spite of enhanced efforts, the rates of prematurity didn't change much. It appears, however, that in a subset of patients with progressively decreasing cervical length surgical or medical interventions may be beneficial.
Materials and methods:
Our protocol includes cervical length measurements at 12, 16, and 20 weeks of pregnancy using transvaginal approach in all pregnant patients. A cervical length of less than 25 mm served as an indication for interventions, e.g., cerclage, progesterone therapy, or both depending on the gestational age and preference of patient and doctor. Patients of different group practice using standard management protocol served as a control group. Preterm birth was defined as a delivery between more than 24 and less than 37 weeks of pregnancy, and further subdivided into the ones delivered at less than 32 weeks of pregnancy and those delivered between 32 and 37 weeks.
A total of 1,319 patients comprised the study group and 2,518 – control group. Patients who delivered at less than 32 weeks were considered extreme prematurity, less than 37 weeks – moderate prematurity (Table 1).
|Gestational age at birth||Study group (N=1319)||Control group (N=2518)|
|Under 32 weeks||30 2.3%||78 3.1% *|
|More than 32 weeks, less than 37 weeks||55 4.17%||152 6.03% **|
|Total preterm: 85 6.47% 230 9.13% *|
* P<0.05 ** NS
Our policy of universal cervical length screening at 12, 16, and 20 weeks of pregnancy and indicated interventions confirms its effectiveness in reducing preterm births. It led to decreased incidence of preterm birth at less than 32 weeks and total prematurity rate.