Outcomes and Characteristics of Women That Refuse Universal Transvaginal Cervical Length Screening [22R

Abstract

INTRODUCTION: In America 11.5% of infants are born prematurely, 15% to women without a history of preterm delivery. At St. Francis Hospital we offer transvaginal cervical length screening to all patients between 18 and 24 weeks gestation, as there is strong evidence to suggest screening may prevent preterm birth by identifying high-risk women earlier in pregnancy. As many women still refuse the test, our study compared obstetrical outcomes and characteristics of women who accept or decline transvaginal cervical length screening. METHODS: We conducted a retrospective medical record review of women undergoing second trimester anatomy scans between 18 and 24 wga from March 1, 2014 to September 31, 2014. Women with uterine anomalies, multiple gestations or prior preterm delivery were excluded. To assess the primary outcome, delivery <37 weeks, the screened group was compared to those who declined. Statistical analysis included Student's t test, Chi square analysis, and Fisher's exact test. RESULTS: Of 826 women, 420 (51%) accepted and 406 (49%) women declined screening. Nulliparous women were more likely to accept screening than multiparous women (P<.05). There was no difference in ethnicity between those that accepted or declined screening. There was a higher rate of preterm delivery in the group that declined screening than in the screened group (16% versus 12.4%, P<.05). CONCLUSION: We noted more rejections for cervical length screening than anticipated. Reasons for declining included prior term deliveries, cost concerns, and lack of adequate counseling. Further study will address the influence sonographers have in the acceptance of screening.