History-indicated cerclage: practice patterns of maternal-fetal medicine specialists in the USA.
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.
Fox
Nathan S
NS
Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA. nfox@mfmnyc.com
Gelber
Shari E
SE
Kalish
Robin B
RB
Chasen
Stephen T
ST
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