833: Incidentally found midtrimester shortened cervical length: Practice patterns among U.S. Maternal-fetal medicine specialists

Abstract

The management of incidentally found short cervical length (CL) in a patient without history of prior spontaneous preterm birth (PTB) can vary. While most physicians agree on starting vaginal progesterone, management after CL shortens < 10mm can vary from expectant management with continued vaginal progesterone to cerclage placement with or without vaginal progesterone. The purpose of this study is to elucidate current practice patterns amongst Maternal-Fetal Medicine (MFM) specialists. We conducted an online survey of SMFM members in 2019. The primary outcome was management of varying CL measurements based on gestational age (GA). Variations in management of short CL were assessed descriptively. There were 204 respondents out of an estimated 1500 SMFM members. Practice type included academic (72.9%), private (12.8%) and community (12.8%). Region of practice included Northeast (37.8%), West (16.7%), South (19.2%), and Midwest (26.1%). Universal CL screening was reported by 93.1% (50.7% abdominal, 42.4% transvaginal), with 37.7% initiating screening at 16w0d to 18w0d, and 50.4% at 18w1d to 20w0d. Trends in management of short CL varied based on CL measurement, rather than GA at presentation. At CL < 10mm, management varied between cerclage, vaginal progesterone or cerclage plus vaginal progesterone. Between CL of 10-20mm, 74-91% would start vaginal progesterone. At CL 21-25mm, management varied between expectant management or vaginal progesterone (Figure 1). Suture material, use of preoperative antibiotics and postoperative tocolysis varied. After cerclage placement, 44.6% continued CL surveillance (Figure 2). Substantial differences of opinion exist amongst MFM physicians regarding management of incidentally found short CL in patients without history of PTB. The differences in responses obtained highlight the need for evidence-based guidelines for managing this frequently encountered clinical scenario.View Large Image Figure ViewerDownload Hi-res image Download (PPT)