Cerclage for the prevention of preterm birth in high risk women receiving intramuscular 17-α-hydroxyprogesterone caproate.
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.
Department of Biostatistics, University of Alabama at Birmingham , Birmingham, AL 35294, USA. jszychow@uab.edu
Jeff M
JM
Szychowski
Vincenzo
V
Berghella
John
J
Owen
Gary
G
Hankins
Jay D
JD
Iams
Jeanne S
JS
Sheffield
Annette
A
Perez-Delboy
Deborah A
DA
Wing
Edwin R
ER
Guzman
D000077713:17 alpha-Hydroxyprogesterone Caproate; D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods; D003131:Combined Modality Therapy; D004965:Estrogen Antagonists / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006908:Hydroxyprogesterones / Q000008:administration & dosage*; D007273:Injections, Intramuscular; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D011247:Pregnancy; D018566:Pregnancy, High-Risk / Q000187:drug effects / Q000502:physiology; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012189:Retrospective Studies; D002581:Uterine Cervical Incompetence / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult
D004965:Estrogen Antagonists; D006908:Hydroxyprogesterones; D000077713:17 alpha-Hydroxyprogesterone Caproate