Preterm birth prevention: a role for cervical cerclage when progesterone fails?

  • Am J Obstet Gynecol

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Women with cervical length

Why this matters

  • Preterm birth is the number 1 cause of neonatal morbidity and mortality worldwide and is responsible for long-term childhood disability in the United States.
  • Currently, the Society for Maternal-Fetal Medicine and the American College of Obstetricians and Gynecologists endorse the use of vaginal progesterone for a short cervix.

Key results

  • Cerclage plus vaginal progesterone was associated with a greater mean gestational age at delivery (34 weeks, 3 days vs 27 weeks, 2 days; P<.001>
  • In the cerclage plus progesterone group: 
    • 17 preterm births;
    • 2 were indicated.
  • In the progesterone-alone group: 
    • 33 preterm births;
    • 1 was indicated.
  • Neonatal ICU admissions lower in the cerclage plus progesterone group compared with progesterone alone (36.1% vs 65.7%; P=.018).

Study design

  • Retrospective cohort study of women (age, ≥18 years) with a singleton pregnancy who had at least 2 transvaginal ultrasound cervical length measurements
  • Women were allowed to continue vaginal progesterone alone (n=39) or receive a cervical cerclage in addition to progesterone (n=36).
  • Funding: None disclosed.

Limitations

  • Study is retrospective.
  • Small numbers included.

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