Appalachian Women's perspectives on preterm birth and transvaginal ultrasound cervical length screening: Implications for addressing disparities in preterm birth

Mairead E. Moloney, Anna Hansen, Cynthia T. Cockerham-Morris, Jing Li, Niraj R. Chavan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: Preterm birth (PTB), a pressing issue for US maternal-child health, disproportionately impacts women in Appalachia. Transvaginal ultrasound (TVU) cervical length (CL) screening is the most accurate PTB risk predictor but remains underutilized. This study characterizes the knowledge, attitudes and beliefs of patients with prior PTB concerning PTB prevention efforts and TVU CL screening. Methods: Participants were recruited from community-based health centers in Appalachian Kentucky. Semi-structured interviews and likert-scale surveys were conducted with 22 pregnant women with a history of spontaneous PTB. Methods for data collection were guided by the Consolidated Framework for Implementation Research (CFIR). Results: Most participants reported that TVU was uncomfortable, but none refused it. Most women were able to articulate the benefits of TVU, but several had concerns about its safety in pregnancy. Participants suggested that pregnant women receive more PTB education and self-advocate. They urged providers to take patient concerns seriously, and better educate patients on PTB risks and TVU safety. Discussion: Our study contributes crucial insights about the experience of a vulnerable population as it pertains to PTB prevention and the uptake of TVU CL screening. Our findings emphasize the need for increased efforts to better educate patients on the impact of prematurity and the safety and benefits of TVU CL screening as an evidence-based strategy for PTB prevention.

Original languageEnglish
Article number100558
Issue number3
StatePublished - Sep 2021

Bibliographical note

Funding Information:
AH was supported by from a grant from the National Institute of Child Health and Human Development ( F30HD103319 ) for her research effort on this project. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding Information:
This project was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health (through Grant UL1TR001998 ) and the Building Interdisciplinary Research Careers in Women's Health Program (through ORWH and NIDA grant: K12DA035150 ), both awarded to NRC. Awards to NRC were the primary funding source for all research activities undertaken through this project.

Publisher Copyright:
© 2021


  • Appalachia
  • Health disparities
  • Preterm birth
  • Transvaginal ultrasound

ASJC Scopus subject areas

  • Health Policy


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