Highlights
- •Providers across the U.S. are administering combination therapy to prevent preterm birth.
- •In women with prior sPTB, most respondents would consider combination therapy, most commonly weekly intramuscular progesterone (IM-P) and serial cervical length (CL) measurements.
- •In patients with incidentally dilated cervix, PRCRN members were most likely to offer dual therapy (cerclage + VP), whereas SMFM respondents were most likely to continue with VP only.
- •In women with a history of cervical insufficiency, PRCRN respondents were most likely to offer a combination ofinterventions.
Abstract
Objective
Our objective was to examine if US obstetrician-gynecologists (OBGYNs) practice outside
of evidenced-based guidelines and use a combination of interventions to prevent spontaneous
preterm birth (sPTB).
Study design
An electronic survey was distributed to members of the Pregnancy-Related Care Research
Network (PRCRN), and also to members of the Society of Maternal-Fetal Medicine (SMFM).
The survey consisted of questions regarding physician demographics, and the use of
interventions to prevent sPTB in women with 1) a prior sPTB, 2) an incidental short
cervix (no prior sPTB), and 3) a history of cervical insufficiency.
Results
The PRCRN response rate was 58.6% (283/483) with an additional 143 responses from
SMFM members. Among PRCRN responders, 82.7% were general OBGYNs and 17.3% were Maternal-Fetal
Medicine subspecialists. Respondents were from all geographic regions of the country;
most practiced in a group private practice (42.6%) or academic institution (31.4%).
In women with prior sPTB, 45.2% of respondents would consider combination therapy,
most commonly weekly intramuscular progesterone (IM-P) and serial cervical length
(CL) measurements. If the patient then develops a short cervix, 33.7% would consider
adding an ultrasound-indicated cerclage. In women with an incidental short cervix,
66.8% of respondents were likely to recommend single therapy with daily vaginal progesterone
(VP). If a patient developed an incidentally dilated cervix, 40.8% of PRCRN respondents
would recommend dual therapy, most commonly cerclage + VP, whereas 64.3% of SMFM respondents
were likely to continue with VP only. In women with a history of cervical insufficiency,
47% of PRCRN respondents indicated they would consider a combination of IM-P, history-indicated
cerclage and serial CL measurements.
Conclusion
Although not currently supported by evidence-based medicine, combination therapy is
commonly being used by U.S. OBGYNs to prevent sPTB in women with risk factors such
as prior sPTB, short or dilated cervix or more than one of these risks.
Keywords
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Article info
Publication history
Published online: September 09, 2021
Accepted:
September 7,
2021
Received in revised form:
August 31,
2021
Received:
April 29,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
