title: History-indicated cerclage: practice patterns of maternal-fetal medicine specialists in the USA.
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.
authors.affiliation: Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA. nfox@mfmnyc.com
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Fox
authors.forename: Shari E
authors.initials: SE
authors.lastname: Gelber
authors.forename: Robin B
authors.initials: RB
authors.lastname: Kalish
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Chasen
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011295:Prenatal Care / Q000379:methods*; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D014481:United States; D002581:Uterine Cervical Incompetence / Q000175:diagnosis / Q000601:surgery