番茄社区

DALLAS -- An educational intervention about cervical length screening meant that fewer women -- including a lower portion of African-American women -- declined screening, researchers said here.

The proportion of women saying "no" to cervical length screening declined following the educational intervention (12.2% before vs 8.4% after, adjusted OR 0.65, 95% CI 0.60-0.78), and this was significant when examined by race (adjusted OR 0.57, 95% CI 0.45-0.71 for African Americans vs adjusted OR 0.75, 95% CI 0.64-0.88, P=0.04 for interaction), reported Lorene A. Temming, MD, of Washington University School of Medicine in St. Louis, and colleagues in a at the Society for Maternal-Fetal Medicine Annual Pregnancy Meeting.

There are "dramatic disparities" in preterm birth based on race, with African Americans having more than one-third higher than the national rate of preterm birth, and double the rate of infant mortality, Temming noted.

But recent data found racial disparities in the acceptance of cervical length screening, with African-American women more likely to decline the procedure, even though transvaginal cervical length screening has been advocated as a screening tool to prevent preterm birth.

After a brief survey that identified the reasons why patients were likely to accept or decline cervical length screening, the researchers devised an educational tool. They developed a script for sonographers, including that the recommendation for cervical length screening "is for everyone, it's not painful, it's short and it's recommended if a patient is at risk for preterm birth," Temming said.

Her group examined rates of cervical length screening both pre-intervention (2015) and post-intervention (June 2016-May 2017), with cervical length screening offered in an "opt-out fashion" for all women with singleton, viable pregnancies without current or planned cerclage.

Overall, the study looked at 4,121 eligible women pre-intervention and 4,156 eligible women post-intervention. Women in the post-intervention group were slightly older (mean age of 30 vs 29) and less likely to have a history of preterm birth. Notably, one-third of each cohort was African American.

Before the intervention, 14.1% of African-American patients declined screening compared with 8.1% after the intervention. The numbers were slightly smaller for non-African American patients (11.3% vs 8.5%, respectively).

Courtney Olson-Chen, MD, of the University of Rochester Medical Center in New York, noted that prior studies found that "African-American women are less likely to understand the importance of cervical length screening, and they are less likely to report having a discussion with their provider regarding this screen."

"We have seen disparities in preterm birth rates among our African-American patients. I don't think we have looked at our local data regarding cervical length screening acceptance rates, but I do think this intervention would be quite helpful for all women including those who are African American," Olson-Chen, who was not involved in the study, told 番茄社区.

Temming's group found the only risk factor for declining screening among those who received intervention was multi-parity (adjusted RR 1.37, 95% CI 1.06-1.77).

One participant at the presentation said that some patients believe treatments that may help prevent preterm birth, such as vaginal progesterone and cerclage are "experimental," and that educational interventions such as this may help improve trust with patients.

Olson-Chen described the intervention as "low cost and should not cause excessive burden to the workflow," adding that "I would love for us to use a similar intervention in our practice."