INTRODUCTION: To assess the additional benefits of 17-hydroxyprogesterone caproate (17-OHPC) therapy in preventing recurrent spontaneous preterm birth in women with an ultrasound-indicated cerclage. METHODS: Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE, Scielo and the Cochrane Central Register of Controlled Trials) were searched for studies published before September 2018. Keywords included “preterm birth,” “ultrasound-indicated cerclage,” “pregnancy” and “17-hydroxyprogesterone caproate.” The primary outcome was preterm birth at <35 weeks of gestation. Meta-analysis was performed using DerSimonian and Laird procedures. Risk of bias and quality assessment was performed using the ROBINS-I and GRADE tools respectively. RESULTS: Four studies met inclusion criteria and were included in the final analysis. Of the 332 women, 115 (34.6%) received ultrasound-indicated cerclage alone, and 217 (65.4%) received adjuvant 17-OHPC. The primary outcome, preterm birth <35 weeks of gestation, was present in 87/217 singleton pregnancies. Though there was a trend towards a reduced risk of preterm birth, the summary estimate of effect was not statistically significant when comparing cerclage alone to cerclage plus 17-OHPC at <35 weeks (RR: 0.95, 95% CI: 0.77-1.17). Similarly, we found no differences in preterm birth at <24 weeks (RR: 0.30, 95% CI: 0.06-1.60), <28 weeks (RR: 0.57, 95% CI: 0.13-2.53) and <32 weeks (RR: 0.99, 95% CI: 0.44-2.27) when comparing cerclage alone to cerclage plus 17-OHPC. There were no differences in fetal birth weight, intraventricular hemorrhage and necrotizing enterocolitis comparing cerclage alone to cerclage plus 17-OHPC. CONCLUSION: Intramuscular 17-OHPC in combination with ultrasound-indicated cerclage in women with prior preterm birth had no additional effect in reducing spontaneous recurrent preterm birth or improving perinatal outcomes.
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