P-752 Cervical cerclage versus vaginal progesterone in the prevention of preterm birth in singleton pregnancies among women with a short cervical length: A retrospective cohort study

Abstract

Abstract Study question To compare the maternal and neonatal effects of cervical cerclage and vaginal progesterone in preventing singleton preterm births in women with a short cervical length. Summary answer Cervical cerclage showed no benefit in preventing preterm birth; however, it prolonged gestation by 39 days compared to vaginal progesterone treatment. What is known already Clinically, there may be a bias toward the choice of cervical cerclage if the cervix is short (<10 mm) and, similarly, toward vaginal progesterone use if the cervix is long (>30 mm). However, there are no clear treatment guidelines for the best options for singleton pregnant women with a CL between 10 and 30 mm. Furthermore, there is insufficient evidence to determine whether one treatment is superior to the other in preventing PTB and decreasing adverse neonatal outcomes in singleton pregnancies in such cases. Study design, size, duration Asymptomatic pregnant women having singleton pregnancies, with a CL between 10 and 30 mm, measured using transvaginal ultrasound at 12–26 weeks of gestation, who delivered at our hospital between January 2009 and August 2020, were included in our study. Based on the inclusion and exclusion criteria, 267 singleton pregnant women, of whom 116 were treated with cervical cerclage and 151 with vaginal progesterone, were finally included. Participants/materials, setting, methods Independent sample t-tests and differential analysis were used to analyze the data based on their distribution. The Cox semi-parametric regression model was used to analyze the gestation weeks at delivery and neonatal outcomes. The decision regarding cesarean delivery was based on a binary logistic regression model. Main results and the role of chance In the initial analysis, the number of preterm births was significantly higher in the cerclage group than in the vaginal progesterone group; however, after multivariate adjustment for confounding factors, the latency period from diagnosis to delivery was found to be significantly prolonged in the cerclage group. Limitations, reasons for caution There are currently no uniform criteria for determining whether study subjects are eligible for cervical cerclage or vaginal progesterone treatment, which may present some cases of noncompliance. Wider implications of the findings In our study, we found that cervical cerclage did not have significant advantages over vaginal progesterone treatment in preventing PTB. However, upon adjustment for confounding factors, it was shown to prolong the gestational age by 39 days compared to vaginal progesterone treatment. Trial registration number non-clinical trials