Incidentally Found Midtrimester Shortened Cervical Length: Practice Patterns among American Maternal–Fetal Medicine Specialists

Farrah N. Hussain; Zainab Al-Ibraheemi; Elianna Kaplowitz; Bijal Parikh; Kristina Martimucci Feldman; Melissa Chu Lam; Lois Brustman; Dawnette Lewis

doi:10.1055/a-1877-6491

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2023; 40(04): 341-347
DOI: 10.1055/a-1877-6491

SMFM Fellowship Series Article

Incidentally Found Midtrimester Shortened Cervical Length: Practice Patterns among American Maternal–Fetal Medicine Specialists

Autoren

Farrah N. Hussain

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
Zainab Al-Ibraheemi

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
Elianna Kaplowitz

²Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, New York
Bijal Parikh

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
Kristina Martimucci Feldman

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
Melissa Chu Lam

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
Lois Brustman

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
Dawnette Lewis

³Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York

Abstract

Objective The management of incidentally found short cervical length (CL) without prior spontaneous preterm birth (PTB) can vary. While most agree on starting vaginal progesterone, management after CL shortens <10 mm varies. The purpose of this study was to elucidate current practice patterns amongst maternal–fetal medicine (MFM) specialists.

Study Design We conducted an online survey of MFM attending physicians and fellows in the United States from May 2019 to April 2020. The primary outcome was management of varying CL based on gestational age. Variations in management were assessed descriptively.

Results There were 236 respondents out of 400 eligible surveyed, with a response rate of 59.2%. Universal CL screening was reported by 93.6% (49.6% abdominal and 44.1% transvaginal). Management of short CL varied based on CL measurement, rather than gestational age at presentation. At CL <10 mm, management included cerclage (17.4–18.7%), vaginal progesterone (41.3–41.7%), or cerclage plus vaginal progesterone (43.4%). Between CL of 10 to 20 mm, the majority (77.4–91.9%) would start vaginal progesterone. At CL 21 to 25 mm, management varied between expectant management (45.5–48.5%) or vaginal progesterone (51.1–52.8%). Suture material used was ethylene terephthalate (47.4%) or polypropelene (31.2). Preoperative antibiotic use was reported by 22.3%, while 45.5% used them only if the amniotic membranes were exposed, and 32.2% reported no antibiotic use. Postoperative tocolytic use varied with 19.3% reporting no use, 32.6% using it always, 8.2% only after significant cervical manipulation, 22.7% after the patient is experiencing symptoms, and 17.6% using it only if the cervix is dilated on exam. After cerclage placement, 44.5% continued CL surveillance.

Conclusion Substantial differences of opinion exist among MFM physicians regarding management of incidentally found short CL in patients without history of PTB. The differences in responses obtained highlight the need for evidence-based guidelines for managing this clinical scenario.

Key Points

There is lack of consensus on the management of incidentally found shortened CL.
The purpose of this study was to elucidate current trends in CL screening and management.
Substantial differences of opinion exist regarding management of incidentally found short CL.

Keywords

preterm birth - short cervix - transvaginal ultrasound - vaginal progesterone - cerclage

Volltext

Referenzen

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