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To evaluate national preterm birth (PTB) prevalence (delivery before 37 weeks) rates in relation to local professional guidelines recommending second trimester ultrasound cervical length measurement.The 2012 guidelines specified cervical length be measured transabdominally, or if not visible transvaginally, at the 19-25 weeks ultrasound anomaly scan; 25 mm would indicate further work-up and treatment, although the type was unspecified. In 2000, the Israel Ministry of Health issued a legal requirement for the submission of delivery records to a national registry. These data were used to compare PTB prevalence before and after the guidelines, as well as trends within each time period. Information was available on multiple pregnancies, maternal age, and parity, as well as low birth-weight. During 2000-2020 there were 3,403,976 live born infants; 1,797,657 before and 1,606,319 after the guidelines.PTB prevalence was 7.64% [95% CI 7.52-7.77] before the guidelines and 6.84% [6.43-7.24] afterwards (P0.0002, 2-tail). Annual PTB prevalence was static in the first period, but declined by 0.18% per annum during the second period. The proportional reduction in PTB prevalence between the periods was 9%, 18% and 24% at 33-36, 28-32 and28 weeks, respectively. Reduced prevalence was observed among singletons (5.49% vs. 4.83%, P0.0001), but not among infants in twin or grand multiple pregnancies. This reduction was statistically significant in the 19-39 years age group, and in both primiparous and multiparous women. Even though reductions were also noted in high risk groups (19 years and over 40 years of age), these did not reach statistical significance. There was a similar reduction in the prevalence of birth-weight under 2,500 g.National guidelines on routine cervical length screening were associated with a fall in PTB prevalence. Whilst direct evidence linking screening with prevalence is lacking, considering the alternatives, this is the most likely explanation. Screening can be readily incorporated into the second trimester anomaly scan. This article is protected by copyright. All rights reserved. |
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