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Am J Perinatol 2019; 36(02): 111-117
DOI: 10.1055/s-0038-1668547
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cervical Cerclage versus Vaginal Progesterone for Management of Short Cervix in Low-Risk Women

Amber M. Wood
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
,
Sarah K. Dotters-Katz
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
,
Brenna L. Hughes
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
› Author Affiliations Funding None.
Further Information

Publication History

21 March 2018

11 July 2018

Publication Date:
15 August 2018 (online)

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Abstract

Objective To evaluate the risk of preterm birth in low-risk women with cervical length (CL) ≤25 mm on transvaginal ultrasound (TVUS) managed with vaginal progesterone (VagP) therapy versus cerclage.

Study Design This is a retrospective cohort of women with no prior history of preterm birth or cervical insufficiency and CL ≤ 25 mm on TVUS, managed with either VagP therapy alone or cerclage (with or without VagP). The primary outcome was rate of preterm delivery < 37 weeks gestational age (GA). Secondary outcomes included delivery at ≤ 32 or ≤ 28 weeks GA, premature preterm rupture of membranes, pregnancy latency, GA at delivery, and composite neonatal outcome.

Results Women undergoing cerclage placement (n = 31) were older and had an earlier GA at the time of diagnosis of short cervix compared with women receiving VagP (n = 62). Delivery at < 37 weeks occurred in 21/62 (33.9%) in the VagP group and 14/31 (45.2%) in the cerclage group (adjusted odds ratio: 1.72, 95% confidence interval: 0.52, 5.66). There were no differences in secondary outcomes.

Conclusion Cerclage compared with VagP therapy did not decrease risk of preterm birth in women with CL ≤ 25 mm. Further research is needed to determine optimal management in such women given a residual 40% risk of preterm birth despite optimal therapy.

Keywords

cervical cerclage - preterm birth - short cervix - vaginal progesterone

Condensation

In low-risk women with CL ≤ 25 mm on TVUS, cerclage does not decrease the risk of preterm birth compared with VagP.


 

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