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Screening and treatment for short cervical length in pregnancy: a physician survey in the United States

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate how physicians in the United States (US) screen for, define, and treat a short cervix to prevent preterm birth.

Methods

This was a cross-sectional, web-based survey of 500 physicians treating pregnant patients with a short cervix in the US. Respondents’ geographic region was monitored to ensure balance across the nine US Census divisions.

Results

Respondents were predominantly obstetrician/gynecologists (86%, 429/500; mean age 49 years). Physicians reported that a median of 90% of their pregnant patients undergo cervical length screening; 81% (407/500) use transvaginal ultrasound. Physicians consult multiple evidence sources to inform their patient care, most commonly clinical guidelines (83%; 413/500) and published research (70%; 349/500). Most physicians (98%; 490/500) reported treating pregnant patients with a short cervix; 95% (474/500) use synthetic and/or natural progestogen, alone or in combination with other treatment modalities. If reimbursement was not a concern, 47% of physicians (230/500) would choose vaginal progesterone as their preferred treatment to prevent preterm birth in all patients with a short cervix, and 45% (218/500) would choose a synthetic progestogen.

Conclusion

US guidelines recommend transvaginal ultrasound for cervical length screening; 81% of physicians in this study reported using this method. Most physicians surveyed use progestogens to treat a short cervix, with approximately half choosing a synthetic progestin (45%) and half choosing natural progesterone (47%) as their preferred treatment, despite national guidelines recommending only vaginal natural progesterone for this indication. Additional physician education is required to implement current and best practices.

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Acknowledgements

Medical writing services were provided by Kate Lothman of RTI Health Solutions; this support was funded by Juniper Pharmaceuticals.

Author information

Authors and Affiliations

  1. Juniper Pharmaceuticals, 33 Arch Street, 31st Floor, Boston, MA, 02110, USA

    Bridget Martell & Herman Weiss

  2. RTI Health Solutions, Research Triangle Park, NC, USA

    Dana B. DiBenedetti, Xiaolei Zhou & Maria Reynolds

  3. Thomas Jefferson University, Philadelphia, PA, USA

    Vincenzo Berghella

  4. Wayne State University, Detroit, MI, USA

    Sonia S. Hassan

Authors
  1. Bridget Martell
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  2. Dana B. DiBenedetti
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  3. Herman Weiss
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  4. Xiaolei Zhou
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  5. Maria Reynolds
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  6. Vincenzo Berghella
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  7. Sonia S. Hassan
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Contributions

All authors participated in data analysis and/or interpretation and contributed to the development of the manuscript, and all authors consented to its submission and publication. Juniper Pharmaceuticals participated in the study design, research, data collection, analysis and interpretation, writing, review, and approval of this publication. The authors’ specific contributions are as follows: BM: Conceptualization, Funding acquisition (lead), Manuscript writing, Interpretation of study data. DBD: Conceptualization, Methodology, Formal analysis, Manuscript writing, Interpretation of study data. HW: Manuscript writing, Interpretation of study data. XZ: Methodology, Formal analysis (lead), Manuscript writing, Interpretation of study data. MR: Methodology, Formal analysis, Manuscript writing, Interpretation of study data. VB: Manuscript writing, Interpretation of study data. SSH: Manuscript writing, Interpretation of study data.

Corresponding author

Correspondence to Herman Weiss.

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Funding

This research and the preparation of this publication were funded by Juniper Pharmaceuticals.

Conflict of interest

B.M. and H.W. are employees of Juniper Pharmaceuticals. D.B.D., X.Z., and M.R. are employees of RTI Health Solutions. This research was performed under a contract between Juniper Pharmaceuticals and RTI Health Solutions. V.B. and S.H. report no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study procedures and materials were submitted to the institutional review board of RTI International, the responsible organization (submission ID 13956). The study was considered exempt from full review, per the Code of Federal Regulations, Part 46 (45CFR46.101[b]), of the US Health and Human Services’ Office for Human Research Protections.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Martell, B., DiBenedetti, D.B., Weiss, H. et al. Screening and treatment for short cervical length in pregnancy: a physician survey in the United States. Arch Gynecol Obstet 297, 601–611 (2018). https://doi.org/10.1007/s00404-017-4619-y

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