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Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 3/2018

01-03-2018 | Maternal-Fetal Medicine

Screening and treatment for short cervical length in pregnancy: a physician survey in the United States

Authors: Bridget Martell, Dana B. DiBenedetti, Herman Weiss, Xiaolei Zhou, Maria Reynolds, Vincenzo Berghella, Sonia S. Hassan

Published in: Archives of Gynecology and Obstetrics | Issue 3/2018

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Abstract

Purpose

To evaluate how physicians in the United States (US) screen for, define, and treat a short cervix to prevent preterm birth.

Methods

This was a cross-sectional, web-based survey of 500 physicians treating pregnant patients with a short cervix in the US. Respondents’ geographic region was monitored to ensure balance across the nine US Census divisions.

Results

Respondents were predominantly obstetrician/gynecologists (86%, 429/500; mean age 49 years). Physicians reported that a median of 90% of their pregnant patients undergo cervical length screening; 81% (407/500) use transvaginal ultrasound. Physicians consult multiple evidence sources to inform their patient care, most commonly clinical guidelines (83%; 413/500) and published research (70%; 349/500). Most physicians (98%; 490/500) reported treating pregnant patients with a short cervix; 95% (474/500) use synthetic and/or natural progestogen, alone or in combination with other treatment modalities. If reimbursement was not a concern, 47% of physicians (230/500) would choose vaginal progesterone as their preferred treatment to prevent preterm birth in all patients with a short cervix, and 45% (218/500) would choose a synthetic progestogen.

Conclusion

US guidelines recommend transvaginal ultrasound for cervical length screening; 81% of physicians in this study reported using this method. Most physicians surveyed use progestogens to treat a short cervix, with approximately half choosing a synthetic progestin (45%) and half choosing natural progesterone (47%) as their preferred treatment, despite national guidelines recommending only vaginal natural progesterone for this indication. Additional physician education is required to implement current and best practices.
Appendix
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Metadata
Title
Screening and treatment for short cervical length in pregnancy: a physician survey in the United States
Authors
Bridget Martell
Dana B. DiBenedetti
Herman Weiss
Xiaolei Zhou
Maria Reynolds
Vincenzo Berghella
Sonia S. Hassan
Publication date
01-03-2018
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 3/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-017-4619-y

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