TY - JOUR
T1 - Does adjunctive use of progesterone in women with cerclage improve prevention of preterm birth?*
AU - Sinkey, Rachel G.
AU - Garcia, Mercedes R.
AU - Odibo, Anthony O.
N1 - Publisher Copyright:
© 2017 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2018/1/17
Y1 - 2018/1/17
N2 - Objective: To evaluate outcomes among pregnancies with cerclage as compared to cerclage and adjunctive progesterone. Methods: A retrospective cohort study was performed from 1 October 2011–30 June 2015 including women with a singleton gestation with vaginal cerclage. Exclusion criteria included multiple gestations, simultaneous 17-alpha hydroxyprogesterone caproate (17-OHPC) and vaginal progesterone (vag-p) use, and patients lost to follow-up. Primary outcome was prevention of preterm birth less than 35 (PTB <35) weeks gestational age (GA). Results: One hundred thirty-six patients met inclusion criteria; 73 women had cerclage only, 53 had cerclage and 17-OHPC, 10 had cerclage and vag-p. GA at cerclage placement was similar across groups (p = 0.068). There was a difference in prevention of PTB <35 weeks GA among groups (p = 0.035) with a trend toward earlier delivery among patients with cerclage and vag-p. Rates of PTB <35 weeks in the cerclage (29%) and cerclage and 17-OHPC groups (34%) were similar (p = 0.533). The odds ratio for risk of PTB <35 weeks among women with cerclage and vag-p as compared to all other patients was 5.21 (95%CI: 1.3–21.2). Conclusion: The combination of cerclage with intramuscular progesterone resulted in similar PTB prevention as compared to cerclage alone. There may be an association between cerclage, vaginal progesterone and higher rates of PTB which may be attributed to characteristics of the group rather than the therapies studied.
AB - Objective: To evaluate outcomes among pregnancies with cerclage as compared to cerclage and adjunctive progesterone. Methods: A retrospective cohort study was performed from 1 October 2011–30 June 2015 including women with a singleton gestation with vaginal cerclage. Exclusion criteria included multiple gestations, simultaneous 17-alpha hydroxyprogesterone caproate (17-OHPC) and vaginal progesterone (vag-p) use, and patients lost to follow-up. Primary outcome was prevention of preterm birth less than 35 (PTB <35) weeks gestational age (GA). Results: One hundred thirty-six patients met inclusion criteria; 73 women had cerclage only, 53 had cerclage and 17-OHPC, 10 had cerclage and vag-p. GA at cerclage placement was similar across groups (p = 0.068). There was a difference in prevention of PTB <35 weeks GA among groups (p = 0.035) with a trend toward earlier delivery among patients with cerclage and vag-p. Rates of PTB <35 weeks in the cerclage (29%) and cerclage and 17-OHPC groups (34%) were similar (p = 0.533). The odds ratio for risk of PTB <35 weeks among women with cerclage and vag-p as compared to all other patients was 5.21 (95%CI: 1.3–21.2). Conclusion: The combination of cerclage with intramuscular progesterone resulted in similar PTB prevention as compared to cerclage alone. There may be an association between cerclage, vaginal progesterone and higher rates of PTB which may be attributed to characteristics of the group rather than the therapies studied.
KW - Cerclage
KW - cervical insufficiency
KW - intramuscular progesterone
KW - preterm birth
KW - vaginal progesterone
UR - http://www.scopus.com/inward/record.url?scp=85011256298&partnerID=8YFLogxK
U2 - 10.1080/14767058.2017.1280019
DO - 10.1080/14767058.2017.1280019
M3 - Article
C2 - 28068860
AN - SCOPUS:85011256298
SN - 1476-7058
VL - 31
SP - 202
EP - 208
JO - Journal of Maternal-Fetal and Neonatal Medicine
JF - Journal of Maternal-Fetal and Neonatal Medicine
IS - 2
ER -