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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

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

Nathan S. Fox1 / Shari E. Gelber2 / Robin B. Kalish3 / Stephen T. Chasen4

1Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA

2Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA

3Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA

4Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA

Corresponding author: Nathan S. Fox, MD Maternal Fetal Medicine Associates PLLC 70 East 90th Street New York, NY 10128 USA Tel.: 1-212-722-7409 Fax: 1-212-722-7185

Citation Information: Journal of Perinatal Medicine. Volume 36, Issue 6, Pages 513–517, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/JPM.2008.083, July 2008

Publication History

Received:
2008-03-29
Revised:
2008-04-14
Accepted:
2008-04-21
Published Online:
2008-07-24

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.

Keywords: Cerclage; history-indicated; prophylactic; second trimester loss; SMFM

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[1]
Kristin M. Knight and David N. Hackney
Journal of Maternal-Fetal and Neonatal Medicine, 2012, Volume 25, Number 6, Page 864

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