Use of the cervical cerclage: comparison of a community and university hospital setting

To compare the use of cervical cerclage between a community hospital and a university teaching hospital to estimate if the rate of cervical cerclage placement differs and if indications selected for cervical cerclage placement vary by institution type.

A review of medical records from January 1, 2000, through December 31, 2004, of women undergoing cervical cerclage was performed at a community hospital and a university teaching hospital. The rate of cerclage and indications for placement were estimated. A multivariate logistic regression model examined the likelihood that women with a specific indication for cerclage would be more likely found in a university hospital or in a community hospital. The analysis was adjusted for confounding variables.

During the 5-year period, 41,458 and 17,153 deliveries occurred at the community hospital and the university teaching hospital, respectively. Rate of cerclage placement was higher at the community hospital 2.6% (n=1,076) than at the university hospital 0.57% (n=98), P<.01. The community hospital had more elective (94.6% versus 83.7%) and fewer emergency cerclages (5.4% versus 16.3%) than the university hospital, P<.01. More cerclages were placed at the community hospital for the diagnosis of cervical cone biopsy/loop electrocautery excision procedure (LEEP), short cervix, or multiple gestations, P<.05. Multivariate logistic regression confirmed that patients with an indication of cone biopsy/LEEP, short cervix, or multiple gestations were more likely to be found in a community hospital setting, P<.01.

Obstetricians in private practice use cervical cerclage more frequently than their colleagues in a university hospital setting.

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