History-indicated cerclage: Practice patterns of maternal-fetal medicine specialists in the USA

Nathan S. Fox, Shari E. Gelber, Robin B. Kalish, Stephen T. Chasen

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Objective: There is limited evidence supporting the effectiveness of history-indicated cerclage in preventing spontaneous pregnancy loss or preterm birth. This study was undertaken to estimate the practice patterns of maternal-fetal medicine specialists in regards to history-indicated cerclage. Methods: We performed a mail-based survey of all SMFM specialists in the US. Subjects were asked whether they would recommend a history-indicated cerclage at 12-14 weeks in a patient whose prior pregnancy was her first pregnancy and ended in a spontaneous, painless loss at 19 weeks with no identifiable cause. Results: A total of 827 (46%) of SMFM members responded of which 75% would recommend a history-indicated cerclage for this patient. Twenty-one percent would not recommend one, but would place one if desired by the patient. Only 4% would not place a history-indicated cerclage in this scenario. A total of 71% believed a history-indicated cerclage was associated with moderate or significant benefit, and 89% believed it involved minimal or no risk. Female gender, non-academic practice, practicing in the southern region and greater interval since residency training were all independently associated with the recommendation for a history-indicated cerclage. Conclusions: Despite limited level-I evidence supporting its use, a history-indicated cerclage is recommended by most maternal-fetal medicine specialists.

Original languageEnglish
Pages (from-to)513-517
Number of pages5
JournalJournal of Perinatal Medicine
Volume36
Issue number6
DOIs
StatePublished - Nov 2008
Externally publishedYes

Keywords

  • Cerclage
  • History-indicated
  • Prophylactic
  • SMFM
  • Second trimester loss

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