Progesterone Supplementation after Cerclage Does Not Improve the Preterm Birth Rate

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.