Cerclage for the prevention of preterm birth in high risk women receiving intramuscular 17-α-hydroxyprogesterone caproate.

Authors

• Jeff M Szychowski
• Vincenzo Berghella
• John Owen
• Gary Hankins
• Jay D Iams
• Jeanne S Sheffield
• Annette Perez-Delboy
• Deborah A Wing
• Edwin R Guzman

Publication/Presentation Date

12-1-2012

Abstract

OBJECTIVE: To assess cerclage benefit in women with short cervix also receiving 17-α-hydroxyprogesterone caproate (17P) to prevent recurrent preterm birth (PTB).

METHODS: Secondary analysis of a multicenter trial of ultrasound-indicated cerclage for shortened cervical length (CL). Women with prior spontaneous PTB at 16-33 6/7 weeks, singleton gestation and CL < 25 mm between 16 and 22 6/7 weeks were counseled on use of 17P and randomized to cerclage or no cerclage. Outcomes of women who received 17P were analyzed by randomization group. Primary outcome was PTB < 35 weeks.

RESULTS: 99 women received 17P: 47 cerclage; 52 no cerclage. Rates of PTB < 35 weeks were similar, 30% for cerclage and 38% for no cerclage (aOR 0.64 (0.27-1.52)). In women with CL < 15 mm, PTB < 35 weeks was reduced for the cerclage group (17% vs. 75%, p = 0.02). However, this difference was nullified after controlling for total progesterone doses received (p = 0.40).

CONCLUSIONS: Cerclage was shown not to offer additional benefit for the prevention of recurrent PTB in women with short CL < 25 mm receiving 17P, but the sample size is insufficient for a definite conclusion given the 36% nonsignificant decrease in the odds of PTB < 35 weeks. Cerclage may further offer substantial benefit to women with very short CL < 15 mm and further study is needed.

Volume

25

Issue

12

First Page

2686

Last Page

2689

ISSN

1476-4954

Published In/Presented At

Szychowski, J. M., Berghella, V., Owen, J., Hankins, G., Iams, J. D., Sheffield, J. S., Perez-Delboy, A., Wing, D. A., Guzman, E. R., & Vaginal Ultrasound Trial Consortium (2012). Cerclage for the prevention of preterm birth in high risk women receiving intramuscular 17-α-hydroxyprogesterone caproate. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 25(12), 2686–2689. https://doi.org/10.3109/14767058.2012.717128

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

22889234

Department(s)

Administration and Leadership

Document Type

Article