(472) Use of perioperative neonatology consultation with periviable cervical cerclage placement: a survey of providers nationwide.

Clinical management of individuals with evidence of cervical insufficiency in the periviable period varies widely. An ultrasound-indicated (UC) or exam-indicated (PEC) cerclage may prolong pregnancy and reduce preterm birth rates as well as associated neonatal morbidity. However these procedures do involve risk as well, such that some patients choose expectant management or termination. Neonatology consultation may assist with patient-centered decision making when considering these options. We aim to elucidate current perioperative practices for periviable cerclage placement among Maternal-Fetal Medicine (MFM) physicians.

Study Design:

A survey was available to all MFM members of the Society for Maternal-Fetal Medicine from February-May 2022 asking about perioperative practices for UC and PEC between 22 0/7 through 22 6/7 weeks (22 weeks) and between 23 0/7 through 23 6/7 weeks (23 weeks). UC and PEC were defined in the survey instructions. Only those who responded “yes” to offering UC and PEC were asked about their willingness to offer perioperative neonatology consult as an adjunct, which this abstract specifically addresses. Rates of recommended consultation were calculated. Chi-square analysis and Fisher’s exact test were used to test for differences according to physician characteristics (number of years in practice, practice model, and region of practice in the country).

Results:

406 responses (response rate 18.1%) revealed that at 22 weeks, 39.8% would offer neonatology consultation prior to UC and 45.6% prior to PEC. At 23 weeks, 73.1% would offer consultation prior to UC and 82.8% prior to PEC (Table 1). At 22 weeks, providers with > 10 years of practice as well as those practicing in the West or Northeast were the least likely to offer consultation prior to both UC and PEC (Table 2).


Conclusion:

Multidisciplinary management with neonatology is important to those who offer periviable cerclage, however its use currently varies significantly according to region of the country and the number of years practicing. These differences reflect the need for evidence-based guidelines in these scenarios.