Q5 Should cervical length be routinely measured as part of 17–22 week ultrasound assessment? Study ref Design LoE N Aim/methods Results Comments SLR I 3 RCTs Aim: to evaluate the effect of Three trials including a total of 287 There is a significant () knowledge of the TVS cervical length singleton gestations with threatened association between 287 (CL) in preventing PTB in singleton PTL between 24+0 and 35+6 weeks knowledge of TVS CL and women pregnancies presenting with were included in the meta-analysis, of lower incidence of PTB threatened PTL. which 145 were randomized to CL and later gestational age screening with knowledge of results at delivery in symptomatic Methods: We searched the Cochrane and 142 to no knowledge of CL. singleton gestations with Pregnancy and Childbirth Group’s Trials threatened PTL. Given that Register and the Cochrane Compared with the control group, in the meta-analysis we Complementary Medicine Field’s Trials women who were randomized to the found a significant 36% Register (May 2016) and reference lists known CL group had a significantly reduction in the primary <37 of retrieved studies. Selection criteria lower rate of PTB weeks (22.1 vs outcome, but other included RCTs of singleton gestations 34.5%; RR 0.64 (95%CI 0.44 to 0.94); 3 outcomes were mostly with threatened PTL randomised to trials; n=287) and a later gestational statistically similar, further management based mainly on CL age at delivery (MD 0.64 (95%CI 0.03 study needs to be screening (intervention group), or CL to 1.25) weeks; MD, 4.48 (95% CI, undertaken to understand screening with no knowledge of results days; 3 trials; n=287). better whether the or no CL screening (control group). All other outcomes for which there predictive characteristics Participants included women with were available data were similar in of CL screening by TVS singleton gestations at 23+0 to the two groups. can be translated into 36+6weeks with threatened PTL. better clinical management and therefore better outcomes and under what circumstances.
Q5 Should cervical length be routinely measured as part of 17–22 week ultrasound assessment? Study ref Design LoE N Aim/methods Results Comments () SLR I 3 RCTs 287 women Aim: to evaluate the effect of knowledge of the TVS cervical length (CL) in preventing PTB in singleton pregnancies presenting with threatened PTL. Methods: We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register and the Cochrane Complementary Medicine Field’s Trials Register (May 2016) and reference lists of retrieved studies. Selection criteria included RCTs of singleton gestations with threatened PTL randomised to management based mainly on CL screening (intervention group), or CL screening with no knowledge of results or no CL screening (control group). Participants included women with singleton gestations at 23+0 to 36+6weeks with threatened PTL. Three trials including a total of 287 singleton gestations with threatened PTL between 24+0 and 35+6 weeks were included in the meta-analysis, of which 145 were randomized to CL screening with knowledge of results and 142 to no knowledge of CL. Compared with the control group, women who were randomized to the known CL group had a significantly lower rate of PTB <37 weeks (22.1 vs 34.5%; RR 0.64 (95%CI 0.44 to 0.94); 3 trials; n=287) and a later gestational age at delivery (MD 0.64 (95%CI 0.03 to 1.25) weeks; MD, 4.48 (95% CI, days; 3 trials; n=287). All other outcomes for which there were available data were similar in the two groups. There is a significant association between knowledge of TVS CL and lower incidence of PTB and later gestational age at delivery in symptomatic singleton gestations with threatened PTL. Given that in the meta-analysis we found a significant 36% reduction in the primary outcome, but other outcomes were mostly statistically similar, further study needs to be undertaken to understand better whether the predictive characteristics of CL screening by TVS can be translated into better clinical management and therefore better outcomes and under what circumstances.
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