Martell Bridget, DiBenedetti Dana B, Weiss Herman, Zhou Xiaolei, Reynolds Maria, Berghella Vincenzo, Hassan Sonia S
Juniper Pharmaceuticals, 33 Arch Street, 31st Floor, Boston, MA, 02110, USA.
RTI Health Solutions, Research Triangle Park, NC, USA.
Arch Gynecol Obstet. 2018 Mar;297(3):601-611. doi: 10.1007/s00404-017-4619-y. Epub 2017 Dec 21.
To evaluate how physicians in the United States (US) screen for, define, and treat a short cervix to prevent preterm birth.
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.
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.
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.
评估美国医生如何筛查、界定和治疗宫颈短缩以预防早产。
这是一项基于网络的横断面调查，对美国500名治疗宫颈短缩孕妇的医生进行了调查。监测受访者的地理区域，以确保美国九个普查分区的分布均衡。
受访者主要是妇产科医生（86%，429/500；平均年龄49岁）。医生报告称，他们的孕妇患者中，中位比例为90%接受宫颈长度筛查；81%（407/500）使用经阴道超声。医生会参考多种证据来源来指导患者护理，最常见的是临床指南（83%；413/500）和已发表的研究（70%；349/500）。大多数医生（98%；490/500）报告治疗过宫颈短缩的孕妇；95%（474/500）使用合成和/或天然孕激素，单独或与其他治疗方式联合使用。如果报销不是问题，47%的医生（230/500）会选择阴道孕激素作为预防所有宫颈短缩患者早产的首选治疗方法，45%（218/500）会选择合成孕激素。
美国指南推荐使用经阴道超声进行宫颈长度筛查；本研究中81%的医生报告使用了这种方法。大多数接受调查的医生使用孕激素治疗宫颈短缩，尽管国家指南仅推荐阴道天然孕激素用于该适应症，但约一半医生选择合成孕激素（45%），另一半选择天然孕激素（47%）作为首选治疗方法。需要进一步对医生进行教育，以落实当前的最佳实践。
