title: Vaginal progesterone vs. cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix, previous preterm birth, and singleton gestation: a systematic review and indirect comparison metaanalysis.
abstract: OBJECTIVE
  No randomized controlled trial has compared vaginal progesterone and cervical cerclage directly for the prevention of preterm birth in women with a sonographic short cervix in the mid trimester, singleton gestation, and previous spontaneous preterm birth. We performed an indirect comparison of vaginal progesterone vs cerclage using placebo/no cerclage as the common comparator.
  
  
  METHODS
  Adjusted indirect metaanalysis of randomized controlled trials.
  
  
  RESULTS
  Four studies that evaluated vaginal progesterone vs placebo (158 patients) and 5 studies that evaluated cerclage vs no cerclage (504 patients) were included. Both interventions were associated with a statistically significant reduction in the risk of preterm birth at <32 weeks of gestation and composite perinatal morbidity and mortality compared with placebo/no cerclage. Adjusted indirect metaanalyses did not show statistically significant differences between vaginal progesterone and cerclage in the reduction of preterm birth or adverse perinatal outcomes.
  
  
  CONCLUSIONS
  Based on state-of-the-art methods for indirect comparisons, either vaginal progesterone or cerclage are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the mid trimester, singleton gestation, and previous preterm birth. Selection of the optimal treatment needs to consider adverse events, cost and patient/clinician preferences.
authors.affiliation: Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA.
authors.forename: Agustin
authors.initials: A
authors.lastname: Conde-Agudelo
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.forename: Kypros
authors.initials: K
authors.lastname: Nicolaides
authors.forename: Tinnakorn
authors.initials: T
authors.lastname: Chaiworapongsa
authors.forename: John M
authors.initials: JM
authors.lastname: O'Brien
authors.forename: Elcin
authors.initials: E
authors.lastname: Cetingoz
authors.forename: Eduardo
authors.initials: E
authors.lastname: da Fonseca
authors.forename: George
authors.initials: G
authors.lastname: Creasy
authors.forename: Priya
authors.initials: P
authors.lastname: Soma-Pillay
authors.forename: Shalini
authors.initials: S
authors.lastname: Fusey
authors.forename: Cetin
authors.initials: C
authors.lastname: Cam
authors.forename: Zarko
authors.initials: Z
authors.lastname: Alfirevic
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Hassan
mesh_terms: D000282:Administration, Intravaginal; D023802:Cerclage, Cervical; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000517:prevention & control*; D011374:Progesterone / Q000008:administration & dosage / Q000627:therapeutic use*; D011372:Progestins / Q000008:administration & dosage / Q000627:therapeutic use*; D014463:Ultrasonography
chemical_list: D011372:Progestins; D011374:Progesterone