Prevention of preterm birth with combined vaginal progesterone & cervical cerclage
Combined treatment of cervical cerclage and vaginal progesterone achieves a greater reduction in preterm birth than in single therapy.
PUBLICATIONS
A systematic review and meta-analysis studied if combined therapy offers superior effectiveness vs. single therapy in prevention of preterm birth.
High-risk, singleton, pregnant patients (shortened cervical length <25mm or previous preterm birth) were assigned cervical cerclage, vaginal progesterone, or both for prevention of preterm birth.
Primary outcome: birth <37 weeks and secondary outcomes: birth <28 weeks, <32 weeks and <34 weeks, gestational age at delivery, days between intervention and delivery, PPROM, cesarean delivery, neonatal mortality, NICU admission, intubation, and birthweight were assessed.
Combined therapy was associated with lower risk of preterm birth at <37 weeks than cerclage alone or progesterone alone.
Compared with cerclage only, combined therapy was associated with preterm birth at <34 weeks, <32 weeks, or <28 weeks, decreased neonatal mortality, increased birthweight, increased gestational age, and a longer interval between intervention and delivery.
Compared with progesterone alone, combined therapy was associated with preterm birth at <32 weeks, <28 weeks, decreased neonatal mortality, increased birthweight, and increased gestational age.
There were no differences in any other secondary outcomes.