Incidentally Found Midtrimester Shortened Cervical Length: Practice Patterns among American Maternal-Fetal Medicine Specialists.

OBJECTIVE: The management of incidentally found short cervical length (CL) without prior spontaneous preterm birth (PTB) can vary. While most agree on starting vaginal progesterone, management after CL shortens <10 mm varies. The purpose of this study was to elucidate current practice patterns amongst maternal-fetal medicine (MFM) specialists. STUDY DESIGN: We conducted an online survey of MFM attending physicians and fellows in the United States from May 2019 to April 2020. The primary outcome was management of varying CL based on gestational age. Variations in management were assessed descriptively. RESULTS: There were 236 respondents out of 400 eligible surveyed, with a response rate of 59.2%. Universal CL screening was reported by 93.6% (49.6% abdominal and 44.1% transvaginal). Management of short CL varied based on CL measurement, rather than gestational age at presentation. At CL <10 mm, management included cerclage (17.4-18.7%), vaginal progesterone (41.3-41.7%), or cerclage plus vaginal progesterone (43.4%). Between CL of 10 to 20 mm, the majority (77.4-91.9%) would start vaginal progesterone. At CL 21 to 25 mm, management varied between expectant management (45.5-48.5%) or vaginal progesterone (51.1-52.8%). Suture material used was ethylene terephthalate (47.4%) or polypropelene (31.2). Preoperative antibiotic use was reported by 22.3%, while 45.5% used them only if the amniotic membranes were exposed, and 32.2% reported no antibiotic use. Postoperative tocolytic use varied with 19.3% reporting no use, 32.6% using it always, 8.2% only after significant cervical manipulation, 22.7% after the patient is experiencing symptoms, and 17.6% using it only if the cervix is dilated on exam. After cerclage placement, 44.5% continued CL surveillance. CONCLUSION: Substantial differences of opinion exist among 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 clinical scenario. KEY POINTS: · There is lack of consensus on the management of incidentally found shortened CL.. · The purpose of this study was to elucidate current trends in CL screening and management.. · Substantial differences of opinion exist regarding management of incidentally found short CL..

The Accuracy of Group Beta Streptococcus Rectovaginal Cultures at 35 to 37 Weeks of Gestation in Predicting Colonization Intrapartum.

Objective This study aims to investigate accuracy of group beta Streptococcus (GBS) rectovaginal cultures at 35 to 37 weeks in predicting intrapartum colonization. Study Design Institutional review board (IRB) approved prospective cohort study of 302 women from October 2015 to May 2017. Patients had the following tests for GBS: first trimester urine culture, rectovaginal culture at 35 to 37 weeks, and intrapartum rectovaginal culture. Outcomes included accuracy of 35- to 37-week GBS rectovaginal culture in detecting results intrapartum, and accuracy of first trimester urine culture in comparison to intrapartum rectovaginal cultures. Results There was sufficient evidence of agreement between results at 35 to 37 weeks with intrapartum cultures ( p = 0.001). However, agreement was weak, 11 patients (3.7%) were GBS positive intrapartum but negative at 35 to 37 weeks; and 33 patients (11%) were initially GBS positive but were negative intrapartum. Sensitivity and specificity of the 35- to 37-week culture was 69% (95% confidence interval [CI]:54-84%) and 87% (95% CI: 83-91%), respectively. There was also weak agreement between first trimester urine culture and intrapartum rectovaginal culture. Specificity for this assessment was 98% (95% CI: 97-100%) and was significantly different compared with antepartum GBS culture ( p < 0.001). Accuracy between antepartum GBS rectovaginal culture and urine culture was similar (85 vs. 87%, p = 0.47). Conclusion The 35- to 37-week GBS rectovaginal culture might be a poor predictor for intrapartum colonization.