Investigating the role of ultrasound assessment of cervical lenght in asymptomatic women at anomaly scan in Malta

Abstract

Purpose: Preterm birth is a major cause of neonatal morbidity and mortality. Although cervical shortening is considered an indicative factor for preterm birth, several aspects about cervical length measurement remain controversial. Objectives: The objectives of this study were to assess cervical length in asymptomatic pregnant women at anomaly scan; compare transabdominal and transvaginal ultrasound assessment; identify any relationship between demographic or clinical characteristics; cervical length or gestation at delivery; and establish a cut-off for cervical length. Methodology: A quantitative, non-experimental, prospective study design was adopted. The cervical length of 79 asymptomatic women was assessed between 19- and 24 weeks’ gestation, using transabdominal and transvaginal ultrasound. Statistical analyses examined correlations between demographic and clinical characteristics, cervical length, and gestation at delivery. Results: Transabdominal and transvaginal cervical length measurements showed a strong positive correlation (p <.001), with no statistically significant difference in mean values (1.19 mm, p = 0.214). Transvaginal cervical length was significantly associated with race-ethnicity, smoking status, termination of pregnancy, uterine anomalies, and mode and gestation at previous delivery. For spontaneous onset deliveries, gestation at delivery was significantly associated with BMI, and previous obstetric complications. For iatrogenic onset deliveries, gestation at delivery was significantly associated with race-ethnicity, smoking status, parity, uterine anomalies, age, and previous obstetric complications. The gestation at delivery was positively correlated with both transabdominal (p = .022) and transvaginal (p = .005) cervical length measurements. Conclusions: Cervical length assessment during the anomaly scan, using the transabdominal approach, may help identify low-risk women at increased risk of preterm birth, especially among Asian women or women who stopped smoking in pregnancy. Targeted cervical length screening may be considered in these women, pending cost benefit analysis. Further research with larger samples is recommended, particularly in women with prior termination of pregnancy or uterine anomalies.