Vaginal Progesterone versus Cerclage for Preventing Preterm Birth in Asymptomatic Singleton Pregnant Women with a History of Preterm Birth

Abstract Background: Preterm birth is a hazard for deleterious short and long-term health outcomes. Cerclage is not a fit for all clinical situations Progesterone clearly plays a role in the maintenance of pregnancy through the relaxant effect of progesterone on myometrial strips in vitro. The progesterone usage in the prevention of preterm birth (PTB) in both singleton and multiple pregnancies has been broadly investigated. Aim of Study: Was to compare the efficacy of vaginal progesterone and cerclage in preventing preterm birth. Patients and Methods: This randomized prospective study was conducted at Al-Hussien University Hospital and Kafr El-Sheikh General Hospital during the period from May 2018 to September 2021. A total 150 pregnant women at high risk of preterm birth who were chosen from the outpatient clinics. They all had singleton pregnancy with gestational age at the first antenatal visit of 12-16 weeks. Additionally, they had history of previous spontaneous preterm labor, and they all presented with sonographic cervical length <25mm in mid trimester. Results: It was observed that in cases who received vaginal progesterone in vaginal progesterone the mean gestational age was (35.68±2.63 weeks) while it was (36.14±2.11 weeks) in those who underwent cerclage. The mean gestational age improved in the cerclage groups by about 3.92 days. The gestational age at delivery was higher in the cerclage group than that in the progesterone group, but without significant difference (p=0.239). There was statistically significant dif-ference between the both studied groups regarding mean birth weight as it was 2185.9±314.2 in women who received vaginal progesterone compared to 2305.8±234.6 in women who un-derwent cerclage; with p=value=0.025) this may be due to higher percentage of term pregnancy in cerclage group than progesterone one. The mean Apgar score at 1 minute was higher in the cerclage group than that in the progesterone groups (7.79 vs. 7.72). This results showed that the di erence in the mean Apgar score was not statistically significant between the progesterone and the cerclage groups (p=0.809).
Conclusion: Either vaginal progesterone or cervical cer-clage had a significant beneficial effect in the protection against preterm delivery and improving perinatal outcomes among high risk women with a singleton gestation, previous spontaneous preterm birth or a mid trimester sonographic short cervix.