Progesterone and cerclage together for short cervix: evaluating potential complementary effects for improved preterm...

Area of Science:

• Maternal-Fetal Medicine
• Obstetrics
• Reproductive Medicine

Background:

• Short cervical length (CL) on transvaginal ultrasound (TVU) is a risk factor for spontaneous preterm birth (SPTB).
• Management typically involves vaginal progesterone or cervical cerclage, often viewed as alternatives.

Purpose of the Study:

• To review the evidence for using vaginal progesterone and cervical cerclage as complementary therapies for short cervical length.
• To evaluate the potential benefits of combining these interventions for preventing preterm birth.

Main Methods:

• Review of current level 1 evidence from randomized controlled trials (RCTs) and meta-analyses.
• Analysis of guidelines and observational data on combined therapy use.

Main Results:

• Vaginal progesterone is recommended for CL ≤25 mm before 24 weeks in singleton gestations without prior SPTB.
• In cases of progressive shortening or prior SPTB, cerclage (ultrasound-indicated cerclage - UIC) may be considered alongside continued progesterone.
• Limited data suggest potential complementary effects of combined progesterone and cerclage, reducing PTB incidence compared to monotherapy.

Conclusions:

• Combined use of vaginal progesterone and cerclage shows potential for preventing preterm birth in women with short cervical length.
• Current evidence is limited, primarily from observational studies; further high-quality research is necessary.
• International guidelines should consider addressing the combined approach for managing short midtrimester cervical length.