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Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Medicine
  • Maternal-Fetal Medicine

Background:

  • Cervical insufficiency is a leading cause of preterm delivery.
  • Cerclage placement is a common intervention to prevent preterm birth.
  • The role of adjuvant progesterone following cerclage remains controversial.

Purpose of the Study:

  • To evaluate the efficacy of adjuvant progesterone in reducing preterm delivery rates after transvaginal cerclage.
  • To assess the impact of progesterone supplementation on maternal and neonatal outcomes.
  • To analyze the effect of progesterone formulation and cerclage indication on outcomes.

Main Methods:

  • Retrospective cohort review of 451 patients undergoing transvaginal cerclage (2005-2021).
  • Comparison of preterm delivery rates (<37 weeks) between patients with and without adjuvant progesterone.
  • Multivariable regression, subgroup, and propensity score matching analyses were performed.

Main Results:

  • Adjuvant progesterone was associated with an increased rate of preterm delivery (45% vs. 34%, p=0.03).
  • Median latency from cerclage to delivery was shorter with progesterone use (119 vs. 139 days, p<0.001).
  • No significant differences in secondary maternal or neonatal outcomes were observed.

Conclusions:

  • Adjuvant progesterone following cerclage does not decrease preterm delivery rates and may be associated with harm.
  • Current data do not support a synergistic benefit of cerclage and postcerclage progesterone.
  • Further research is needed to establish guidelines for progesterone use after cerclage.