Adjunctive Therapies to Cerclage for the Prevention of Preterm Birth: A Systematic Review

Abstract

The aim of this paper is to provide a thorough summary of published studies that have assessed the efficacy of adjunctive therapies used in addition to cervical cerclage as a preventive measure for preterm birth. We limited our paper to patients treated with cerclage plus an additional prophylactic therapy compared to a reference group of women with cerclage alone. The specific adjunctive therapies included in this systematic review are progesterone, reinforcing or second cerclage placement, tocolytics, antibiotics, bedrest, and pessary. We searched PubMed and Cochrane databases without date criteria with restriction to English language and human studies and performed additional bibliographic review of selected articles and identified 305 total studies for review. Of those, only 12 studies compared the use of an adjunctive therapy with cerclage to a reference group of cerclage alone. None of the 12 were prospective randomized clinical trials. No comparative studies were identified addressing the issues of antibiotics, bedrest, or pessary as adjunctive treatments to cerclage. None of the 12 studies included in this paper demonstrated a clear benefit of any adjunctive therapy used in addition to cerclage over and above cerclage used alone; however, few studies with small numbers limited the strength of the conclusions.

Retracted: Effect of adjunctive vaginal progesterone after McDonald cerclage on the rate of second‐trimester abortion in singleton pregnancy: a randomized controlled trial

“…A systematic review previously addressed the progesterone therapy as an adjunct to cerclage . The studies included in that review used only the synthetic progestin 17α‐hydroxyprogesterone caproate (17‐OHPC) and were not randomized.…”

“…Many studies have demonstrated the beneficial effect of vaginal progesterone among women with either a risk of preterm delivery or a short cervix . To our knowledge, only one systematic review has addressed progesterone as an adjunctive therapy to cerclage, and none of the included studies focused on the rate of spontaneous abortion . Recently, adjuvant vaginal progesterone therapy for women who underwent cervical cerclage indicated by physical or ultrasound examination was found to be associated with decreased rates of preterm delivery birth rate and admission to the neonatal intensive care unit (NICU).…”

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

“…11,12 Several studies have evaluated the effect of adjuvant progesterone supplementation on cerclage but have not provided evidence indicating that adjuvant progesterone administration results in further reduction in the SPTB rate in women who have undergone cerclage. [13][14][15][16][17] These studies focused on the additive effect of 17-α-hydroxyprogesterone caproate (17OHP-C), however, and not on that of vaginal natural progesterone treatment. The patients included in these studies had undergone ultrasound-indicated cervical cerclage, and not PEICC.…”

Role of 17-Hydroxyprogesterone Caproate as an Adjuvant Therapy in Women With Cervical Cerclage for Prevention of Preterm Delivery: A Retrospective Matched Controlled Study

“…It has been proven that cerclage alone decreases the rate of preterm birth [1]. Obstetricians rely on incorporating other adjunct therapies with cerclage, which has proved to be effective to prevent preterm birth [14].…”