Developing a quality assurance program for transvaginal cervical length measurement at 18-21 weeks' gestation.
cervical length
preterm birth
quality assurance
screening
ultrasound
Journal
The Australian & New Zealand journal of obstetrics & gynaecology
ISSN: 1479-828X
Titre abrégé: Aust N Z J Obstet Gynaecol
Pays: Australia
ID NLM: 0001027
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
received:
29
12
2018
accepted:
21
03
2019
pubmed:
30
5
2019
medline:
1
12
2020
entrez:
30
5
2019
Statut:
ppublish
Résumé
Preterm birth is the leading cause of death in children under the age of five years. Transvaginal cervical length (TVCL) assessment can be used to predict preterm delivery risk at the mid-trimester scan. To optimise the screening tool, developing and maintaining quality standards is important. To develop an Australian reference range for TVCL at 18.0-21.0 weeks' gestation, quality standards for measurement and audit mechanisms for ultrasound operators. A retrospective audit was performed of consecutive patients scanned at 18.0-21.0 weeks' gestation. Each TVCL measurement ultrasound image was reviewed, and exclusions were made based on a defined set of quality criteria. Fractional polynomial Bayesian methodology was used to establish a reference range. Central tendency, dispersion plots and cumulative sum charts for operators in the original reference range cohort were created. These plots were then applied to a second validation cohort of operators to establish the efficacy of this quality assurance audit tool. Median TVCL from 1031 participants was 36.0 mm (interquartile range 32.7-40.0 mm), which was independent of gestational age. The quality audit tool was applied to 15 operators from the reference cohort with a mean cervix length multiple of the median of 1.01 and a mean SD log10 cervix length multiple of the median of 0.06. Of the 22 operators in the validation cohort, 20 (90.9%) demonstrated ideal or acceptable central tendency results, and 19 (86.4%) remained in the appropriate cumulative sum zone. An Australian cervix length measurement reference range at 18.0-21.0 weeks' gestation has been developed along with a validated quality assurance audit tool for ultrasound operators.
Sections du résumé
BACKGROUND
Preterm birth is the leading cause of death in children under the age of five years. Transvaginal cervical length (TVCL) assessment can be used to predict preterm delivery risk at the mid-trimester scan. To optimise the screening tool, developing and maintaining quality standards is important.
AIMS
To develop an Australian reference range for TVCL at 18.0-21.0 weeks' gestation, quality standards for measurement and audit mechanisms for ultrasound operators.
MATERIALS AND METHODS
A retrospective audit was performed of consecutive patients scanned at 18.0-21.0 weeks' gestation. Each TVCL measurement ultrasound image was reviewed, and exclusions were made based on a defined set of quality criteria. Fractional polynomial Bayesian methodology was used to establish a reference range. Central tendency, dispersion plots and cumulative sum charts for operators in the original reference range cohort were created. These plots were then applied to a second validation cohort of operators to establish the efficacy of this quality assurance audit tool.
RESULTS
Median TVCL from 1031 participants was 36.0 mm (interquartile range 32.7-40.0 mm), which was independent of gestational age. The quality audit tool was applied to 15 operators from the reference cohort with a mean cervix length multiple of the median of 1.01 and a mean SD log10 cervix length multiple of the median of 0.06. Of the 22 operators in the validation cohort, 20 (90.9%) demonstrated ideal or acceptable central tendency results, and 19 (86.4%) remained in the appropriate cumulative sum zone.
CONCLUSION
An Australian cervix length measurement reference range at 18.0-21.0 weeks' gestation has been developed along with a validated quality assurance audit tool for ultrasound operators.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
55-62Informations de copyright
© 2019 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Références
Who.int [Internet]. Geneva: World Health Organisation; 2018. [cited 2018 May 15]. Available from: http://www.who.int/en/news-room/fact-sheets/detail/preterm-birth.
Australian Institute of Health and Welfare. Australia's Mothers and Babies 2014-in brief. Perinatal statistics series no. 32. Cat no. PER 87. Canberra: AIHW; 2016.
Marchofdimes.org [Internet]. White Plains (NY): March of Dimes; 2018. [2018 May 15]. The impact of premature birth on society. Available from: https://www.marchofdimes.org/mission/the-economic-and-societal-costs.aspx.
Van der Ven AJ, van Os MA, Kleinrouweler CE et al. Is cervical length associated with maternal characteristics? Eur J Obstet Gynecol Reprod Biol 2015; 188: 12-16.
Hoesli IM, Strutas D, Tercanli S, Holzgreve W. Charts for cervical length in singleton pregnancy. Int J Gynaecol Obstet 2003; 82: 161-165.
Khalifeh A, Berghella V. Universal cervical length screening in singleton gestation without a prior preterm birth: Ten reasons why it should be implemented. Am J Obstet Gynecol 2016; 214(5): 603-606.
Pedretti M, Kazemier B, Dickinson J, Mol B. Implementing universal cervical length screening in asymptomatic women with singleton pregnancies: challenges and opportunities. Aust N Z J Obstet Gynaecol 2017; 57: 221-227.
Fetalmedicine.org [Internet]. London: The Fetal Medicine Foundation; 2018. [Cited 2018 May 15]. Available from: https://fetalmedicine.org/education/cervical-assessment.
Isuog.org [Internet]. London: ISUOG; 2017. [Cited 2018 May 15]. Available from: https://www.isuog.org.
Hibbard J, Tart M, Moawad AH. Cervical length at 16-22 weeks’ gestation and risk for preterm delivery. Obstet Gynecol 2000; 96(6): 972-978.
Salomon LJ, Diaz-Garcia C, Bernard JP, Ville Y. Reference range for cervical length throughout pregnancy: non-parametric LMS-based model applied to a large sample. Ultrasound Obstet Gynecol 2009; 33: 459-464.
Celik E, To M, Gajewska K et al. ; Fetal Medicine Foundation Second Trimester Screening Group. Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment. Ultrasound Obstet Gynecol 2008; 31: 549-554.
Wilson JMG, Jungner G. Principles and Practice of Screening for Disease: World Health Organization Public Health Papers Vol. 34 [Internet]. Geneva: WHO, 1968. [cited 2018 May 15]. Available from: http://whqlibdoc.who.int/php/WHO_PHP_34.pdf.
Andermann A, Blancquaert I, Beauchamp S, Costea I. Guiding policy decisions for genetic screening: developing a systematic and transparent approach. Public Health Genomics 2011; 14: 9-16.
Ridding G, Hyett JA, Sahota D, Mclennan AC. Assessing quality Standards in measurement of uterine artery pulsatility index at 11 to 13 + 6 weeks’ gestation. Ultrasound Obstet Gynecol 2015; 46: 299-305.
Sahota DS, Chen M, Leung TK et al. Assessment of sonographer nuchal translucency measurement performance - central tendency and dispersion. J Matern Fetal Neonatal Med 2011; 24: 812-816.
Sahota DS, Leung WC, To WK et al. Quality assurance of nuchal translucency for prenatal fetal Down syndrome screening. J Matern Fetal Neonatal Med 2012; 25: 1039-1043.
Kagan KO, Sonek J. How to measure cervical length. Ultrasound Obstet Gynecol 2015; 45: 358-362.
Schwarz GE. Estimating the dimension of a model. Ann Stat 1978; 6(2): 461-464.
Wit E, van den Heuvel E, Romeyn J-W. ‘All models are wrong…’: an introduction to model uncertainty. Stat Neerl 2012; 66(3): 217-236.
Iams JD et al. The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med 1996; 334(9): 567-572.
Boelig RC, Feltovich H, Spitz JL et al. Assessment of transvaginal ultrasound cervical length image quality. Obstet Gynecol 2017; 129(3): 536-554.
Grigg OA, Farewell VT, Spiegelhalter DJ. Use of risk-adjusted CUSUM and RSPRT charts for monitoring in medical contexts. Stat Methods Med Res 2003; 12: 147-170.
Sabrià J, Barceló-Vidal C, Arigita M et al. The CUSUM test applied in prospective nuchal translucency quality review. Ultrasound Obstet Gynecol 2011; 37: 582-587.
Peixoto AB, Cunha Caldas TM, Alamy AH et al. Reference values for the cervical length measurement in the second trimester of pregnancy using the transvaginal ultrasound in a large Brazilian population. Obstet Gynecol Sci 2016; 59(4): 303-306.
Silva SV, Damiao R, Fonseca EB et al. Reference ranges for cervical length by transvaginal scan in singleton pregnancies. J Matern Fetal Neonatal Med 2010; 23(5): 379-382.
Biau DJ, Resche-Rigon M, Godiris-Petit G et al. Quality control of surgical and interventional procedures: a review of the CUSUM. Qual Saf Health Care 2007; 16(3): 203-207.
Leung TN, Pang MW, Leung TY et al. Cervical length at 18-22 weeks of gestation for prediction of spontaneous preterm delivery in Hong Kong Chinese women. Ultrasound Obstet Gynecol 2005; 26: 713-717.
Wulff CB, Rode L, Rosthøj S et al. Transvaginal sonographic cervical length in first and second trimesters in a low-risk population: a prospective study. Ultrasound Obstet Gynecol 2018; 51: 604-613.