title: Diagnosis of short cervix in a community hospital prior to placement of a therapeutic cerclage.
abstract: The purpose of this study was to describe how obstetricians in the community define a short cervix prior to cerclage placement. A secondary analysis of cerclages placed for the diagnosis of short cervix, defined by either digital or ultrasound examination, were identified from a cohort of 1076 cerclages placed at a community hospital from January 1, 2000, through December 31, 2004. Two hundred twenty-six cerclages were placed for the diagnosis of short cervix. Fifty-eight women (25.7%) were nulliparous. The mean estimated gestational age at placement was 15.4 +/- 3.8 weeks. More than half of the cerclages (n = 125; 55.3%) were placed prior to 15 weeks estimated gestational age. Of those cases with documented cervical length by ultrasound (n = 171), 36 of these patients (21.1%) had a cervical length of > or = 25 mm. The most common indications for cerclage placement were short cervix only (40.3%), previous cone biopsy/loop electrocautery excision procedure (28.8%), and multiple gestation (9.7%). In a community hospital, cerclages for short cervix are often performed in nulliparous women without antecedent risk factors at a gestational age when cervical length is not a reliable tool for predicting adverse pregnancy outcome.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
authors.forename: Carla A
authors.initials: CA
authors.lastname: Martinez
authors.forename: Mark A
authors.initials: MA
authors.lastname: Turrentine
authors.forename: Mildred M
authors.initials: MM
authors.lastname: Ramirez
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D054791:Cervical Length Measurement / Q000379:methods*; D002584:Cervix Uteri / Q000033:anatomy & histology*; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control; D012189:Retrospective Studies