Study of the Effectiveness of Cervical Cerclage versus Progesterone in Preterm Labor. A Comparative Clinical Trial

Abstract

Background: Patients with a singleton pregnancy, a history of spontaneous preterm delivery, and a short cervix may benefit from  preterm birth prevention strategies that involve vaginal progesterone treatment as well as the placement of a cervical cerclage. Clinical  use of vaginal progesterone is preferred over cervical cerclage because it is less expensive and does not require invasive surgery to prevent premature labor. This study aims at comparing the efficacy of using both vaginal and intramuscular progesterone versus cervical  cerclage for prevention of the preterm birth among females with previous history of preterm birth.

Methods: One hundred and  twenty pregnant females with an increased risk of preterm labor (assessed by a previous preterm birth (PTB) or transvaginal ultrasound  (TVUS) findings of a shortened cervix which is less than 25 mm participated in this randomized controlled study at the Obstetrics and Gynecological Department of Zagazig University Hospital. Group A: 62 pregnant women had progesterone therapy in the form of vaginal  suppositories 400mg twice per day and intramuscular long-acting progesterone per week at 13 weeks to 37 weeks gestational age. Group  B: (Cervical Cerclage group) 58 pregnant women who had Cervical Cerclage at 13 weeks’ gestation without progesterone. All data  regarding the timing of labor onset, along with maternal and neonatal complications were documented.

Results: Cervical length is  significantly increased in the cerclage group from 1.877+.41 cm to 2.18+.31 cm with P value <0.001 after doing the cerclage. When compared to the cervical cerclage, progesterone use yielded similar effects with non-statistically significant differences in terms of  method of delivery, pregnancy fate, and neonatal outcomes.

Conclusion: The progesterone is successful as cervical cerclage in  preventing preterm labor, but its usage could be better in clinical as it's noninvasive method and economic.