Cervical Length Measurement for Predicting Preterm Birth: Clinical Guidelines and Evidence
DOI:
https://doi.org/10.52340/healthecosoc.2026.10.02.15Keywords:
cervical cerclage, cervical length, preterm birth, screening, transvaginal ultrasonography, vaginal progesteroneAbstract
Introduction: Preterm birth is a major cause of perinatal morbidity and mortality. Midtrimester transvaginal ultrasound measurement of cervical length is one of the most informative clinical predictors of spontaneous preterm birth. Aim of the study is to summarize current clinical recommendations and evidence on the predictive value of cervical length measurement, screening strategies, standardized measurement technique, and management of a short cervix, while also considering resource and health-policy implications for implementation. Methodology: This paper is a narrative review of international clinical guidelines, systematic reviews, meta-analyses, and key primary studies addressing transvaginal cervical-length assessment, prediction of preterm birth, vaginal progesterone, cervical cerclage, pessary use, and the cost-effectiveness of screening. Particular attention was given to recently updated international recommendations. Results: Cervical length used to guide treatment should be measured transvaginally using a standardized technique. In singleton pregnancies without a previous spontaneous preterm birth, a midtrimester cervical length of ≤25 mm is commonly used to define a short cervix. Vaginal progesterone is recommended when a transvaginal cervical length of ≤20 mm is diagnosed before 24 weeks, while treatment at 21–25 mm may be considered through shared decision-making. In individuals without a prior preterm birth and without cervical dilation, routine cerclage is not recommended for a sonographic short cervix, and current evidence does not support routine cervical pessary use. The effectiveness and cost-effectiveness of universal screening depend on local prevalence, service capacity, access to treatment, quality assurance, and financing arrangements. Conclusion: Standardized transvaginal cervical-length assessment is an important tool for risk stratification and selection of preventive interventions. Screening policies should be linked to clear clinical pathways, trained personnel, equitable access to effective treatment, and continuous monitoring of process and outcome indicators.
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