Addition of adjuvant progesterone to physical‐exam‐indicated cervical cerclage to prevent preterm birth

Jung, Eun Young; Oh, Kyung Joon; Hong, Joon Seok; Han, Byoung Hee; Joo, Jin Deok

doi:10.1111/jog.13128

Cited by 18 publications

(17 citation statements)

References 39 publications

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“…Eighteen of these women also received concurrent vaginal progesterone from the time of cerclage placement. This was shown to be of benefit for prolonging pregnancy 19 . However, without objective cervical length measurements in this study, it is difficult to appreciate the risk for PTB in each intervention group and thus the true impact of the use of concurrent vaginal progesterone and cervical cerclage in this cohort.…”

Section: Discussionmentioning

confidence: 96%

Rescue Adjuvant Vaginal Progesterone May Improve Outcomes in Cervical Cerclage Failure

Roman

Costa

Júnior

et al. 2018

Geburtshilfe Frauenheilkd

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Introduction Aim of the study was to evaluate the effect of rescue adjuvant vaginal progesterone in women with ongoing, transvaginal ultrasound (TVUS)-confirmed cervical shortening despite cervical cerclage. Materials and Methods A retrospective case control study was performed of women undergoing cervical surveillance following either history- or ultrasound-indicated cervical cerclage. We compared women managed with cervical cerclage and vaginal progesterone to women managed with cervical cerclage alone. Women with a singleton pregnancy who underwent cervical cerclage were identified from a database. Data on the concurrent use of vaginal progesterone, cervical length measurements, interventions and birth outcomes were collected from patient notes and clinical pathology notes. Patients from each intervention group were matched, based on exact shortest cervical length measurements obtained during surveillance and age of gestation when the measurement was obtained. Results 66 women were matched and included in the study, based on exact shortest cervical length measurements. Each group had an identical mean shortest cervical length of 12.09 mm. The outcomes of 33 women who received both cervical cerclage and vaginal progesterone were compared to the outcomes of 33 women who were treated with cervical cerclage alone. The administration of vaginal progesterone to women with ongoing cervical shortening despite cervical cerclage was found to significantly prolong the pregnancy (36.36 weeks vs. 32.63 weeks; p = 0.0036) compared to women treated with cerclage alone. This use of rescue adjuvant vaginal progesterone was also associated with higher birth weights (2829 g vs. 2134 g; p = 0.0065) compared to women who had cervical cerclage alone; however, there was no difference in Apgar scores, composite neonatal morbidity or neonatal intensive care admission. Conclusion Women with cervical shortening despite the presence of cervical cerclage may benefit from further TVUS cervical length surveillance and the administration of vaginal progesterone if further cervical shortening occurs. Despite both groups having clinically significant shortened cervical lengths and cervical cerclage in situ, adjunct vaginal progesterone treatment resulted in older gestational age at birth and higher birth weight. Further investigation and confirmation of this finding in a larger prospective trial is warranted to explore this potential benefit for the management of preterm birth in future.

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Section: Discussionmentioning

confidence: 96%

Rescue Adjuvant Vaginal Progesterone May Improve Outcomes in Cervical Cerclage Failure

Roman

Costa

Júnior

et al. 2018

Geburtshilfe Frauenheilkd

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“…Among the various routes of progesterone delivery, including intramuscular, vaginal, and oral, vaginal progesterone has the advantages of easy accessibility and satisfactory patient compliance. Although expectant management is an alternative to using vaginal progesterone after cerclage for a short CL, randomized studies and long-term safety data are needed to establish consensus guidelines [ 22 23 24 25 26 27 ]. In a retrospective study of 53 singleton pregnancies affected by acute cervical insufficiency treated with cerclage, Jung et al [ 22 ] concluded that vaginal progesterone with physical exam-indicated cerclage was associated with a reduction in spontaneous PTBs.…”

Section: Discussionmentioning

confidence: 99%

History-indicated cerclage: the association between previous preterm history and cerclage outcome

et al. 2018

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ObjectiveOur hospital's policy is to perform history-indicated cerclage (HIC) for pregnant patients with 1 or more second-trimester pregnancy losses. Recently, the American College of Obstetricians and Gynecologists (ACOG) guideline regarding indications for HIC was changed from 3 or more previous second-trimester fetal losses to one or more. In this study, we aimed to evaluate the efficacy of the revised guideline and to investigate the association between previous preterm history and cerclage outcome.MethodsWe conducted a retrospective observational study of cases of HIC in singleton pregnancies performed at our hospital between January 2007 and June 2016. We compared the perioperative complications and incidences of preterm delivery in patients with one previous second-trimester pregnancy loss against those in patients with ≥2 losses.ResultsThe incidence of preterm delivery (<32 weeks) was significantly lower in patients with one previous second-trimester pregnancy loss than in those with ≥2 losses (15/194 [8%] vs. 28/205 [14%]). In the 1 loss and ≥2 losses groups, the rates of preterm premature rupture of membranes (PPROM) were 7% and 8%, the rates of PPROM at <32 weeks 2.1% and 3.4%, and the ratios of neonatal intensive care unit admission 10% and 17%, respectively.ConclusionComparison of HIC in one previous second-trimester pregnancy loss group with HIC in the 2 or more previous second-trimester pregnancy loss group found no difference in pregnancy outcome. This finding supports the amended ACOG guideline for HIC indications. Based on our results, we also propose development of a new protocol for HIC-related complications.

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“…From a previous study, the addition of vaginal progesterone in the rescue cervical cerclage procedure was associated with a reduction of spontaneous preterm births. 16 Maternal complications were significantly higher among those delivered at <34 weeks' gestation, including uterine contractions, vaginal bleeding, and rupture of membranes. Prophylactic cervical cerclage was performed in history-indicated and ultrasound-indicated patients.…”

Section: Median (Iqr)mentioning

confidence: 95%

Success Rate of Cervical Cerclage at Siriraj Hospital

Maneeratprasert

Sutchritpongsa

Boriboonhirunsarn

2019

Smj

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Objective: To determine the success rate of cervical cerclage at Siriraj Hospital and the associated factors. Methods: The study included 90 pregnant women who received cervical cerclage procedures at Siriraj Hospital during 2007-2016. Clinical information and the cerclage procedures were evaluated. Successful cervical cerclage was defined as delivery at 34 weeks' gestation or more. Results: The mean maternal age was 31.8 ± 5 years. The most common indication was history of second trimester abortion (76.7%). The mean gestational age (GA) at cervical cerclage was 18.0 ± 4.3 weeks. The mean cervical length was 25.2 ± 12.0 mm. Most of the patients had no cervical dilatation (76.7%). Almost all the cervical cerclage procedures were performed using McDonald's technique (98.9%). Of the 90 women, 66 (73.3%) delivered at >34 weeks' gestation, while 59.9% delivered at >37 weeks' gestation. The mean birth weight was 2404.9 ± 991.7 grams. The success rate of cervical cerclage increased significantly among women with greater cervical length (28.2±10.5 vs. 18.0±14.9 mm., p=0.002), without cervical dilatation (83.3% vs. 58.3%, p=0.046), without bulging of membranes (92.5% vs. 66.7%, p=0.002), and prophylactic operations (89.4% vs. 58.3%, p=0.001). Maternal complications were significantly lower in women with successful cervical cerclage (9.1% vs. 45.8%, p<0.001). Conclusion: The success rate of cervical cerclage at Siriraj Hospital was 73.3%. Possible associated factors included cervical length, cervical dilatation, bulging of membranes, and the prophylactic procedure.

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Addition of adjuvant progesterone to physical‐exam‐indicated cervical cerclage to prevent preterm birth

Abstract: Adjuvant vaginal progesterone therapy with PEICC was associated with reductions in SPTB, low birthweight, and neonatal intensive care unit admission.

Cited by 18 publications

References 39 publications

Rescue Adjuvant Vaginal Progesterone May Improve Outcomes in Cervical Cerclage Failure

Rescue Adjuvant Vaginal Progesterone May Improve Outcomes in Cervical Cerclage Failure

History-indicated cerclage: the association between previous preterm history and cerclage outcome

Success Rate of Cervical Cerclage at Siriraj Hospital

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