Vaginal progesterone, cerclage or cervical pessary for preventing preterm birth in asymptomatic singleton pregnant women with a history of preterm birth and a sonographic short cervix: Editorial comment

摘要

A major effort to decrease preterm birth rates is directed at preventing recurrent spontaneous preterm birth in singleton pregnancies. Shortened cervical length is one predictor of spontaneous preterm birth, and cervical pessary and cerclage are often used. This study was undertaken to compare the outcomes in women with a singleton pregnancy and history of preterm birth and sonographic short cervix, managed with cerclage, vaginal progesterone, or cervical pessary.The 3 cohorts of asymptomatic women had a singleton pregnancy, a history of at least 1 spontaneous preterm birth at less than 34 weeks, and a short cervix on ultrasonography. Cohort A included 142 women (United States) initially treated with cerclage (with or without 17a-hydroxyprogesterone caproate); cohort B comprised 59 women (United Kingdom) treated with vaginal progesterone followed by cerclage in cases of progressive cervical shortening, and cohort C had 42 women from Spain treated with cervical pessary. Women in cohort A had 1 prior spontaneous preterm birth and received cerclage when the cervical length was less than 25 mm. Management after cerclage followed standard protocols, and the cerclage suture was removed at 37 weeks' gestation. For cohort B, short cervix was defined as 30.5 mm at 16 weeks' gestation and 24.5 mm at 23 weeks' gestation. Women were prescribed 200 mg vaginal progesterone.