503: Implementation of a universal cervical length surveillance program for prediction of preterm birth

Abstract

503 Implementation of a universal cervical length surveillance program for prediction of preterm birth Kelly Orzechowski, Sara Nicholas, Stuart Weiner, Jason Baxter, Vincenzo Berghella Thomas Jefferson University Hospital, Obstetrics & Gynecology, Philadelphia, PA OBJECTIVE: To evaluate factors associated with successful implementation of a universal cervical length (CL) screening program for prediction of preterm birth. STUDY DESIGN: We performed a retrospective cohort study to evaluate the acceptability of universal CL screening program for the prediction of preterm birth (PTB) between January 1, 2012 and June 30, 2012. Women with singleton gestations undergoing obstetric ultrasounds between 18 0/7-23 6/7 weeks were eligible for CL screening. Patients with prior spontaneous PTB were excluded. CL measurements were always performed in a uniform fashion with transvaginal ultrasound and the results were interpreted according to a standard protocol (Figure). Sonographers and medical staff received education prior to implementation and appointment times were extended by 10 minutes. Patients received educational handouts at check-in. On June 1, 2012, our program was modified from “opt-in” to “opt-out” in attempt to improve patient acceptance rates. Independent samples Mann-Whitney U, Chi-square, and independent samples t-tests were performed using SPSS 20.0. RESULTS: During the study period, 733 (82%) of 898 eligible patients were offered CL screening. Women were more likely to accept CL screening if they were nulliparous and if the sonographer was female. Implementation of an “opt-out” CL screening program significantly increased the percentage of women screened (Table). Among 561 women who accepted CL screening, 9 (1.6%) had a CL 25mm and 6 (1%) had a CL 20mm and were offered vaginal progesterone. CONCLUSION: Universal CL screening is acceptable to most women and is feasible to implement on a large scale. Patient education is necessary to achieve optimal rates of acceptance. An “Opt-out” screening approach increases acceptance rates. 504 Does cervical conization increase the risk of a sonographic short cervix in the second trimester of pregnancy? Kelly Orzechowski, Sara Nicholas, Vincenzo Berghella Thomas Jefferson University Hospital, Obstetrics & Gynecology, Philadelphia, PA OBJECTIVE: To evaluate whether prior cervical conization increases the incidence of a sonographic short cervix in the second trimester of pregnancy. STUDY DESIGN: We conducted a retrospective cohort study from January 1, 2012 to June 30, 2012 involving women with singleton gestations between 18 0/7-23 6/7 weeks undergoing universal cervical length (CL) screening with transvaginal ultrasound for prediction of preterm birth. Women with a prior spontaneous preterm birth and those receiving prenatal care at outside institutions were excluded. History of cervical conization including cold knife conization (CKC) and Loop Electrosurgical Excision Procedure (LEEP) was determined by review of the prenatal record. The primary outcomes were mean CL measurement and the incidence of a short cervix (CL 20mm) among women with and without prior cervical conization. Independent samples Mann-Whitney U, Chi-square, and independent samples t-tests were performed using SPSS 20.0. RESULTS: During the study period, 527 women underwent second trimester CL screening, and of those, 33 (6.2%) had a documented history of prior conization (4 CKC and 29 LEEP). Demographic characteristics between the groups are shown in the Table. The mean midtrimester cervical length in women with prior cervical conizations was significantly shorter compared to women without a history of conization (39mm vs. 43mm, p 0.012). Women with prior conization also had a significantly higher incidence of CL 25mm (6% vs. 1%, p 0.046) as well as a non-significant higher incidence of CL 20mm. CONCLUSION: In a universal CL screening program, women with prior cervical conizations have shorter second trimester cervical lengths and a higher incidence of short cervix compared to women without such a history. Universal CL screening algorithm Demographics and outcomes of a universal CL screening program