Vaginal progesterone and cervical cerclage for preterm labor prevention and their impact on perinatal outcome

Abstract

ObjectiveThe main aim of this study was to evaluate the efficacy of progesterone supplementation, cervical cerclage, or a combination of both in the prevention of preterm labor (PTL) and their impact on the perinatal outcome.BackgroundPTL is defined as the presence of uterine contractions of sufficient frequency and intensity to effect progressive effacement and dilation of the cervix before term gestation (between 20 and 37 weeks). Preterm delivery occurs in 5-13% of pregnancies before 37 weeks' gestation.Patients and methodsThe present study was designed as a randomized clinical trial. Only 147 women who fulfilled our inclusion criteria (singleton pregnancy and a history of spontaneous PTL, twin or triplet gestations, sonographic cervical length <25 mm in mid trimester, and gestational age at the first antenatal visit of 12-16 weeks) were assigned randomly to the study. Forty-nine women received vaginal progesterone, 49 women were subjected to cervical cerclage, and 48 women received vaginal progesterone and cerclage.The primary outcome parameter was spontaneous delivery at less than 37 weeks' gestation. The secondary outcome parameter was spontaneous delivery at 34 or less weeks' gestation. The neonatal morbidity parameters were birth weight, Apgar score, and neonatal intensive care unit admission.ResultsThe primary and secondary outcome parameters were significantly improved in the combination group (P = 0.005 and 0.008, respectively); also, the neonatal morbidity parameters (birth weight, Apgar score, and neonatal intensive care unit admission) were significantly improved in the combination group (P = 0.047, 0.003, and 0.002, respectively).ConclusionThe combination of vaginal progesterone and cerclage was found to be significantly more effective in preventing PTL and in improving the perinatal outcomes in the high-risk groups.