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Grand Rounds

Short Cervical Length In Average Risk Patients: How Do MFM Specialists’ Management Strategies Differ?

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BACKGROUND AND PURPOSE:

  • Hussain et al. (Am J Perinatology, 2022) collated current Maternal Fetal Medicine (MFM) practice patterns for short cervical length (CL) among patients without a history of spontaneous preterm birth

METHODS:

  • Online survey
  • Participants
    • MFM attending physicians and fellows in the U.S. from 2019 to 2020
  • Primary outcome
    • Management of varying CL based on gestational age, assessed descriptively

RESULTS:

  • 236 respondents
  • Universal CL screening: 93.6% reported
    • Abdominal: 49.6%
    • Transvaginal: 44.1%
  • Management of short CL varied based on CL measurement rather than gestational age at presentation
    • At CL <10 mm
      • Cerclage: 17.4 to 18.7%
      • Vaginal progesterone: 41.3 to 41.7%
      • Cerclage plus vaginal progesterone: 43.4%
    • At CL 10 to 20 mm
      • Start vaginal progesterone: 77.4 to 91.9%
    • At CL 21 to 25 mm
      • Expectant management: 45.5 to 48.5%
      • Vaginal progesterone: 51.1 to 52.8%
  • For surgical management
    • Suture materials
      • Ethylene terephthalate: 47.4%
      • Polypropylene: 31.2%
    • Antibiotic use
      • Always used pre-operative antibiotic: 22.3%
      • Antibiotic use only if amniotic membranes were exposed: 45.5%
      • No antibiotic use: 32.2%
    • Post-operative tocolytic
      • No use: 19.3%
      • Always used: 32.6%
      • Used only after significant cervical manipulation: 8.2%
      • Used after the patient is experiencing symptoms: 22.7%
      • Used only if the cervix is dilated on exam: 17.6%
    • CL surveillance continues after cerclage placement: 44.5%

CONCLUSION:

  • Management of incidentally found short CL in patients without history of preterm birth varies widely among MFM specialists, highlighting the need for standardized guidelines

Learn More – Primary Sources:

Incidentally found midtrimester shortened cervical length: Practice patterns among American Maternal-Fetal Medicine specialists

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Related ObG Topics:

The Role of Routine Cervical Length Screening For Preterm Birth Prevention
Cervical Cerclage for a Progressively Shortening Cervix or Very Short Cervix
Meta-analysis: Cerclage for Short Cervix but Without History of Preterm Birth 
EPPPIC Meta-analysis Results: Progestogens for Preterm Birth Prevention

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