Implementing universal cervical length screening in asymptomatic women with singleton pregnancies: challenges and opportunities.

Cervical length (CL) screening has been successfully utilised to identify asymptomatic women, with a singleton pregnancy, at risk of preterm birth (PTB), thereby providing an opportunity to offer interventions that may reduce that risk. Cervical length screening with ultrasound is most effectively performed with a transvaginal approach. Universal cervical length screening, encompassing all singleton pregnancies rather than restricting screening to those considered at increased risk of PTB, is currently not widely used, despite a growing body of evidence in support of its utility for PTB prevention. There are a number of barriers that may prevent or restrict the implementation of a universal CL screening program. These include cost, availability of vaginal progesterone and other treatment options, reluctance of women to undergo transvaginal ultrasound and the perceptions and beliefs of medical practitioners. Given that mid-pregnancy CL measurement is a recognised predictor of spontaneous PTB, that most cases of PTB occur with no prior maternal history and that there are interventions available that may reduce the risk of PTB, we believe there is a clear role for routine CL screening to be adopted as a component of the fetal morphology ultrasound examination. As a strategy to reduce PTB rates, discussion and counselling about PTB prevention and CL screening should be adopted as a core element of prenatal care.