Background
Universal transvaginal cervical length screening has been increasingly implemented
with both positive and negative consequences.
Objective
In this study, we described the diagnostic incidence of low-lying placenta and placenta
previa with the implementation of universal transvaginal cervical length screening.
Study Design
This is a retrospective cohort study of women undergoing midtrimester universal transvaginal
cervical length screening. The primary outcome was the rate of transvaginal diagnosis
of low-lying placenta or placenta previa using midtrimester universal transvaginal
cervical length screening.
Results
This study included 1982 midtrimester ultrasounds, of which 211 indicated a low-lying
placenta or placenta previa on either transabdominal or transvaginal ultrasound. With
transvaginal ultrasound, a low-lying placenta or placenta previa was diagnosed in
211 women (10.6% of the study population). Of the 211 patients with a low-lying placenta
or placenta previa, 90 (42.6%) had a false-negative result, diagnosed using only transvaginal
ultrasound; 112 (53.1%) had a true-positive result; and 9 (4.3%) had a false-positive
result. The relative risk of having an abnormal finding on ultrasound with the addition
of universal transvaginal cervical length screening was 9.2 (95% confidence interval,
4.6–18.1). Of the low-lying placenta or placenta previa diagnosed using midtrimester
universal transvaginal cervical length screening, 98.9% resolved (95% confidence interval,
93.7–99.97).
Conclusion
Implementation of universal transvaginal cervical length screening increases the diagnostic
incidence of low-lying placenta or placenta previa without an increase in the diagnoses
that persist to term, which comes at the cost of increased follow-up ultrasounds and
potentially increased anxiety for the patient.
Key words
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References
- Epidemiology and causes of preterm birth.Lancet. 2008; 371: 75-84
- Infant mortality statistics from the 2013 period linked birth/infant death data set.Natl Vital Stat Rep. 2015; 64: 1-30
- Cervical length, risk factors, and delivery outcomes among women with spontaneous preterm birth.J Matern Fetal Neonatal Med. 2016; 29: 2840-2844
- Screening for spontaneous preterm birth and resultant therapies to reduce neonatal morbidity and mortality: a review.Semin Fetal Neonatal Med. 2018; 23: 126-132
- Prediction of patient-specific risk of early preterm delivery using maternal history and sonographic measurement of cervical length: a population-based prospective study.Ultrasound Obstet Gynecol. 2006; 27: 362-367
- The role of routine cervical length screening in selected high- and low-risk women for preterm birth prevention.Am J Obstet Gynecol. 2016; 215: B2-B7
- The American College of Obstetricians and Gynecologists. Practice Bulletin no. 130: prediction and prevention of preterm birth.Obstet Gynecol. 2012; 120: 964-973
- Universal cervical length screening: implementation and outcomes.Am J Obstet Gynecol. 2016; 214: 523.e1-523.e8
- Universal maternal cervical length screening during the second trimester: pros and cons of a strategy to identify women at risk of spontaneous preterm delivery.Am J Obstet Gynecol. 2012; 207: 101-106
- A universal mid-trimester transvaginal cervical length screening program and its associated reduced preterm birth rate.Am J Obstet Gynecol. 2016; 214: 365.e1-365.e5
- Cervical length screening in asymptomatic women at high risk and low risk for spontaneous preterm birth.Clin Obstet Gynecol. 2016; 59: 241-251
- Decrease in the incidence of threatened preterm labor after implementation of transvaginal ultrasound cervical length universal screening.J Matern Fetal Neonatal Med. 2019; 32: 1853-1858
- Universal cervical length screening for preterm birth prevention in the United States.J Matern Fetal Neonatal Med. 2017; 30: 1500-1503
- Prevalence and outcomes of incidental imaging findings: umbrella review.BMJ. 2018; 361: k2387
- The effect of a universal cervical length screening program on antepartum management and birth outcomes.AJP Rep. 2016; 6: e206-e211
- Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies.J Matern Fetal Neonatal Med. 2003; 13: 175-190
- Transabdominal ultrasonography as a screening test for second-trimester placenta previa.Obstet Gynecol. 2014; 123: 628-633
- Confirming the safety of transvaginal sonography in patients suspected of placenta previa.Obstet Gynecol. 1993; 81: 742-744
- Toward consistent terminology of placental location.Semin Perinatol. 2013; 37: 375-379
- Impaired ultrasonographic cervical assessment after voiding: a randomized controlled trial.Obstet Gynecol. 2013; 121: 798-804
- The economic burden of incidentally detected findings.Radiol Clin North Am. 2011; 49: 257-265
Article info
Publication history
Published online: October 08, 2020
Accepted:
September 30,
2020
Received in revised form:
September 18,
2020
Received:
August 10,
2020
Footnotes
The authors report no conflict of interest.
Cite this article as: Sinclair S, Masters HR, DeFranco E, et al. Universal transvaginal cervical length screening during pregnancy increases the diagnostic incidence of low-lying placenta and placenta previa. Am J Obstet Gynecol MFM 2021;3:100255.
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