Abstract：
To compare the prevalence of preterm birth (PTB) (delivery before 37 weeks) in Israel before and after publication of national guidelines recommending second-trimester sonographic cervical-length (CL) measurement.
The Israeli Society of Obstetrics and Gynecology (ISOG) guidelines, issued on 1 January 2012, specified that CL should be measured transabdominally or, if this is not possible, transvaginally, at the 19-25-week ultrasound anomaly scan and that CL < 25 mm should indicate further work-up and treatment, although the type of treatment 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 in the period before (2000-2011) and that after (2012-2020) publication of the guidelines, as well as trends within each time period. Information was available on singleton and multiple pregnancy and maternal age and parity, as well as low birth weight (< 2500 g).
During the period 2000-2020, there were 3 403 976 infants liveborn in Israel: 1 797 657 before and 1 606 319 after publication of the ISOG guidelines. There were 247 187 PTBs overall, with a prevalence of 7.64% (95% CI, 7.52-7.77%) before publication of the guidelines and 6.84% (95% CI, 6.43-7.24%) afterwards (P < 0.0002, two-tailed). The annual PTB prevalence was static in the first time period but declined by 0.18% per annum during the second period, after publication of the guidelines. The proportionate reduction in PTB prevalence after compared with before publication of the guidelines was 10% overall, 9% for PTB at 33-36 weeks, 18% for PTB at 28-32 weeks and 24% for PTB at < 28 weeks. After publication of the guidelines, reduced prevalence of PTB was observed among singletons (5.49% before vs 4.83% after, P < 0.0001), but not among infants in twin or higher-order multiple pregnancy. There was a statistically significant reduction in the rate of PTB following publication of the guidelines in both nulliparous and parous women and in the 19-39-year-old maternal-age group. Although reductions in PTB prevalence were also noted in high-risk age groups (maternal age < 19 years and ≥ 40 years), these did not reach statistical significance. Following publication of the guidelines, there was a statistically significant reduction in the prevalence of birth weight under 2500 g, of a magnitude similar to that for PTB prevalence.
The publication of national guidelines recommending routine CL measurement at the time of the second-trimester anomaly scan was associated with a fall in PTB prevalence in singleton pregnancies. Whilst direct evidence linking screening with this fall in prevalence is lacking, it is likely that implementation of routine CL screening played an important role in the reduction of PTB rate. Our experience indicates that screening can be incorporated into the second-trimester anomaly scan. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
The Israeli Society of Obstetrics and Gynecology (ISOG) guidelines, issued on 1 January 2012, specified that CL should be measured transabdominally or, if this is not possible, transvaginally, at the 19-25-week ultrasound anomaly scan and that CL < 25 mm should indicate further work-up and treatment, although the type of treatment 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 in the period before (2000-2011) and that after (2012-2020) publication of the guidelines, as well as trends within each time period. Information was available on singleton and multiple pregnancy and maternal age and parity, as well as low birth weight (< 2500 g).
During the period 2000-2020, there were 3 403 976 infants liveborn in Israel: 1 797 657 before and 1 606 319 after publication of the ISOG guidelines. There were 247 187 PTBs overall, with a prevalence of 7.64% (95% CI, 7.52-7.77%) before publication of the guidelines and 6.84% (95% CI, 6.43-7.24%) afterwards (P < 0.0002, two-tailed). The annual PTB prevalence was static in the first time period but declined by 0.18% per annum during the second period, after publication of the guidelines. The proportionate reduction in PTB prevalence after compared with before publication of the guidelines was 10% overall, 9% for PTB at 33-36 weeks, 18% for PTB at 28-32 weeks and 24% for PTB at < 28 weeks. After publication of the guidelines, reduced prevalence of PTB was observed among singletons (5.49% before vs 4.83% after, P < 0.0001), but not among infants in twin or higher-order multiple pregnancy. There was a statistically significant reduction in the rate of PTB following publication of the guidelines in both nulliparous and parous women and in the 19-39-year-old maternal-age group. Although reductions in PTB prevalence were also noted in high-risk age groups (maternal age < 19 years and ≥ 40 years), these did not reach statistical significance. Following publication of the guidelines, there was a statistically significant reduction in the prevalence of birth weight under 2500 g, of a magnitude similar to that for PTB prevalence.
The publication of national guidelines recommending routine CL measurement at the time of the second-trimester anomaly scan was associated with a fall in PTB prevalence in singleton pregnancies. Whilst direct evidence linking screening with this fall in prevalence is lacking, it is likely that implementation of routine CL screening played an important role in the reduction of PTB rate. Our experience indicates that screening can be incorporated into the second-trimester anomaly scan. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
目的：评估全国早产（PTB）患病率（37周前分娩）与推荐孕中期超声测量宫颈长度的当地专业指南的关系。
方法：2012年指南规定宫颈长度应通过腹部测量，或者如果经阴道不可见，在19-25周超声异常扫描;<25毫米将表明进一步的检查和治疗，尽管类型未指定。2000年，以色列卫生部发布了一项法律要求，要求将分娩记录提交国家登记册。这些数据用于比较指南前后的PTB患病率，以及每个时间段内的趋势。有关于多胎妊娠的资料,产妇年龄,和平价，以及低出生体重。在2000-2020年期间，有3,403,976名活产婴儿；指南之前有1,797,657名，指南之后有1,606,319名。
结果：指南前PTB患病率为7.64％[95％CI7.52-7.77]，之后为6.84％[6.43-7.24]（P<0.0002，2尾）。在第一阶段，年度PTB患病率是静态的，但在第二阶段每年下降0.18%。两个时期之间的PTB患病率成比例降低为9％，在33-36、28-32和<28周时分别为18%和24%，分别。在单胎中观察到患病率降低（5.49％vs.4.83%,P<0.0001),但不是双胎或多次怀孕的婴儿。这种减少在19-39岁年龄组中具有统计学意义，以及初产妇和多胎妇女。尽管在高危人群（<19岁和40岁以上）中也注意到减少，这些没有达到统计学意义。出生体重低于2,500g的患病率也有类似的降低。
结论：关于常规宫颈长度筛查的国家指南与PTB患病率下降有关。虽然缺乏将筛查与患病率联系起来的直接证据，考虑到替代方案，这是最有可能的解释。筛查可以很容易地结合到妊娠中期异常扫描中。本文受版权保护。保留所有权利。
方法：2012年指南规定宫颈长度应通过腹部测量，或者如果经阴道不可见，在19-25周超声异常扫描;<25毫米将表明进一步的检查和治疗，尽管类型未指定。2000年，以色列卫生部发布了一项法律要求，要求将分娩记录提交国家登记册。这些数据用于比较指南前后的PTB患病率，以及每个时间段内的趋势。有关于多胎妊娠的资料,产妇年龄,和平价，以及低出生体重。在2000-2020年期间，有3,403,976名活产婴儿；指南之前有1,797,657名，指南之后有1,606,319名。
结果：指南前PTB患病率为7.64％[95％CI7.52-7.77]，之后为6.84％[6.43-7.24]（P<0.0002，2尾）。在第一阶段，年度PTB患病率是静态的，但在第二阶段每年下降0.18%。两个时期之间的PTB患病率成比例降低为9％，在33-36、28-32和<28周时分别为18%和24%，分别。在单胎中观察到患病率降低（5.49％vs.4.83%,P<0.0001),但不是双胎或多次怀孕的婴儿。这种减少在19-39岁年龄组中具有统计学意义，以及初产妇和多胎妇女。尽管在高危人群（<19岁和40岁以上）中也注意到减少，这些没有达到统计学意义。出生体重低于2,500g的患病率也有类似的降低。
结论：关于常规宫颈长度筛查的国家指南与PTB患病率下降有关。虽然缺乏将筛查与患病率联系起来的直接证据，考虑到替代方案，这是最有可能的解释。筛查可以很容易地结合到妊娠中期异常扫描中。本文受版权保护。保留所有权利。
