title: Addition of adjuvant progesterone to physical-exam-indicated cervical cerclage to prevent preterm birth.
abstract: OBJECTIVE
  The aim of this study was to assess the effect of vaginal progesterone as an adjuvant therapy to physical-exam-indicated cervical cerclage (PEICC).
  
  
  METHODS
  This retrospective cohort study included 53 consecutive singleton women who underwent PEICC because of acute cervical insufficiency at 17-24 gestational weeks. The study population was divided into two groups: the adjuvant progesterone group (n = 18) and the non-adjuvant group (n = 35). A 200-mg dose of vaginal micronized natural progesterone was administered after cerclage in the adjuvant progesterone group. Primary outcome measure was spontaneous preterm birth (SPTB) at <36 weeks.
  
  
  RESULTS
  The SPTB rate at <36 weeks in the adjuvant group was significantly lower than in the non-adjuvant group (17% vs 51%, P < 0.05). Adjuvant progesterone therapy was significantly associated with a reduction in SPTB at <36 weeks (adjusted odds ratio, 0.12; 95% confidence interval, 0.02-0.69, P < 0.05) even after adjusting for known covariates, including a visible membrane size of ≥4 cm, gestational age, prior SPTB, and use of amnioreduction. The frequency of SPTB at <32 weeks, birthweight < 2500 g, and neonatal intensive care unit admission was significantly lower in the adjuvant progesterone group than in the non-adjuvant group (P < 0.05 for all).
  
  
  CONCLUSIONS
  Adjuvant vaginal progesterone therapy with PEICC was associated with reductions in SPTB, low birthweight, and neonatal intensive care unit admission.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Jung
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea.|Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung Joon
authors.initials: KJ
authors.lastname: Oh
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea.|Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Joon-Seok
authors.initials: JS
authors.lastname: Hong
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea.
authors.forename: Bo Ryoung
authors.initials: BR
authors.lastname: Han
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea.
authors.forename: Jung Kyung
authors.initials: JK
authors.lastname: Joo
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical; D005260:Female; D005865:Gestational Age; D006801:Humans; D010808:Physical Examination; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery; D011374:Progesterone / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011374:Progesterone
keywords: adjuvant therapy; cervical cerclage; cervical insufficiency; spontaneous preterm birth; vaginal progesterone