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Abstract

We thank Pandipati et al1Khalifeh A. Berghella V. Not transabdominal!.Am J Obstet Gynecol. 2016; 215: 739-744.e1Abstract Full Text Full Text PDF PubMed Google Scholar for their interest in our article. As our fight against preterm birth continues, we strive to provide evidence-based interventions while avoiding possible harm to our patients. Universal transvaginal ultrasound (TVU) cervical length (CL) screening to detect a short cervix meets the World Health Organization criteria for a screening test as we have shown in our recently published article,2Khalifeh A. Berghella V. Universal cervical length screening in singleton gestations without a previous preterm birth: ten reasons why it should be implemented.Am J Obstet Gynecol. 2016; 215: 739-744.e1Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar which advocates the use of TVU. We agree with the authors that the transabdominal ultrasound (TAU) approach, even with high cut-offs, will require two thirds of women screened by TAU CL to eventually undergo a TVU CL.3Friedman A.M. Srinivas S.K. Parry S. Elovitz M.A. Wang E. Schwartz N. Can transabdominal ultrasound be used as a screening test for short cervical length?.Am J Obstet Gynecol. 2013; 208: 190.e1-190.e7Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar We also agree with the authors that there is difficulty and a lack of consistency in ascertaining that a cervix is short when a TAU approach is used, for the same reasons we cite in our article.1Khalifeh A. Berghella V. Not transabdominal!.Am J Obstet Gynecol. 2016; 215: 739-744.e1Abstract Full Text Full Text PDF PubMed Google Scholar We are pleased Pandipati et al4Pandipati S. Combs C.A. Fishman A. Lee S.Y. Mallory K. Ianovich F. Prospective evaluation of a protocol for using transabdominal ultrasound to screen for short cervix.Am J Obstet Gynecol. 2015; 2013: 99.e1-99.e13Abstract Full Text Full Text PDF Scopus (11) Google Scholar came to the same conclusion as us, which is that TVU should be the only method to screen for short CL. We agree with their point that “when we hear of providers who find that TVU is needed in only a small percentage of women when TAU is used to pre-screen the cervix, we suspect that either they are not using the appropriate 35−36 mm length cut-off, that they are accepting suboptimal TAU imaging, and/or that they are not assessing for dynamic change.” We are glad Pandipati et al,4Pandipati S. Combs C.A. Fishman A. Lee S.Y. Mallory K. Ianovich F. Prospective evaluation of a protocol for using transabdominal ultrasound to screen for short cervix.Am J Obstet Gynecol. 2015; 2013: 99.e1-99.e13Abstract Full Text Full Text PDF Scopus (11) Google Scholar through an evidence-based approach, strengthen the case for TVU, and against TAU. Understandably, it is for these evidence-based reasons that national and international organizations (American Congress of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, and Fetal Medicine Foundation) have recommended using TVU, and not TAU, as the appropriate method for screening for a short CL.5American College of Obstetricians and Gynecologists Committee on Practice Bulletins–ObstetricsACOG Practice bulletin: prediction and prevention of preterm birth, number 130.Obstet Gynecol. 2012; 120: 964-973Crossref PubMed Scopus (200) Google Scholar, 6Society for Maternal-Fetal Medicine Publications Committee, with assistance of Vincenzo BerghellaProgesterone and preterm birth prevention: translating clinical trials data into clinical practice.Am J Obstet Gynecol. 2012; 206: 376-378Abstract Full Text Full Text PDF PubMed Scopus (282) Google Scholar, 7Fetal Medicine Foundation. Certificates of competence: cervical assessment [Internet]. Available at: https://fetalmedicine.org/cervical-assessment-1. Accessed January 9, 2017.Google Scholar Transabdominal ultrasound for cervical length screening (or not?)American Journal of Obstetrics & GynecologyVol. 216Issue 6PreviewWe read with interest the Point/Counterpoint regarding the relative merits of transabdominal ultrasound (TAU) vs transvaginal ultrasound (TVU) for measuring cervical length.1,2 Although we already were performing universal TVU screening, we were interested in changing to a protocol whereby TAU could be used as a prescreen to select patients for TVU to improve our clinical efficiency. A previous report3 found that a TAU cervical length >35−36 mm was associated with very low probability of short cervix (TVU cervical length <25 mm). Full-Text PDF