Outcomes With Cerclage Alone Compared With Cerclage Plus 17α-Hydroxyprogesterone Caproate

Area of Science:

• Perinatal medicine
• Maternal-fetal medicine
• Obstetrics

Background:

• Prior preterm birth is a significant risk factor for recurrent preterm delivery.
• Cerclage is a procedure used to prevent preterm birth.
• 17α-hydroxyprogesterone caproate is a medication used to reduce preterm birth.

Purpose of the Study:

• To compare perinatal outcomes in women with prior preterm birth who received cerclage alone versus cerclage plus 17α-hydroxyprogesterone caproate.

Main Methods:

• Retrospective cohort study of women with transvaginal cerclage and prior preterm birth.
• Comparison of outcomes between cerclage-only and cerclage plus 17α-hydroxyprogesterone caproate groups.
• Primary outcome: delivery at less than 24 weeks of gestation.

Main Results:

• The cerclage plus 17α-hydroxyprogesterone caproate group had a 69% relative reduction in delivery before 24 weeks (OR 0.31, P=.01).
• Multivariate analysis confirmed a 73% reduction in delivery before 24 weeks in the combined treatment group (aOR 0.26, P=.02).
• No significant difference in overall preterm delivery or preterm PROM between groups.

Conclusions:

• Transvaginal cerclage plus 17α-hydroxyprogesterone caproate significantly reduces early preterm delivery compared to cerclage alone.
• The combined treatment improves the likelihood of a viable neonate.
• Further research may explore optimal timing and indications for combined therapy.