Category: Prematurity
Poster Session I
Interventions to reduce the risk of spontaneous preterm birth in multifetal gestations are limited. Despite recent data from randomized controlled trials (RCT) demonstrating safety and benefit of cerclage placement in multifetal gestations, the question of whether to perform an ultrasound-indicated (UC) or physical exam-indicated (PEC) cerclage remains complex when considering placement in multifetal gestations, particularly during the periviable period. We aimed to elucidate current periviable cerclage placement practices in multifetal gestations among Maternal-Fetal Medicine (MFM) physicians.
Study Design:
A survey of MFM members in the Society for Maternal-Fetal Medicine from February-May 2022 asked providers about their practice 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 instructions. This abstract specifically addresses UC and PEC at each GA in multiple gestations. Rates of cerclage placement were calculated and compared to the rates of UC and PEC in singletons using Fisher’s exact test. Chi-square analysis and Fisher’s exact test assessed response 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 40.7% of MFM physicians would offer UC at 22 weeks and 41.7% at 23 weeks in multiple gestations, compared with 92.1% and 62.6%, respectively, for singleton pregnancies (Table 1). 68.0% of MFM physicians would offer PEC at 22 weeks and 65.4% at 23 weeks in multiple gestations compared to 95.8% and 66.3%, respectively, in singleton gestations (Table 1). There were no differences according to physician characteristics (Table 2).
Conclusion:
Despite recent RCT safety data, about one third to more than one half of providers would not place cerclage in multifetal gestations depending on the scenario. These differences reflect the need for evidence-based guidelines.
Gina F. Milone, MD (she/her/hers)
Fellow Physician
University of California, Irvine
Long Beach, California, United States
Jenny Chang, MPH
University of California, Irvine, School of Medicine
Orange, California, United States
Julia Bregand White, MD
University of California, Irvine
Anaheim, California, United States
Jonathan Steller, MD
Department of Obstetrics and Gynecology, University of California Irvine
Aurora, Colorado, United States