Concurrent progestogen and cerclage to reduce preterm birth: a multicenter international retrospective cohort

• Published in: American journal of obstetrics & gynecology MFM 2024-07, Vol.6 (7), p.101351, Article 101351
• Main Authors: Tolosa, Jorge E., Boelig, Rupsa C., Bell, Joseph, Martínez-Baladejo, María, Stoltzfus, Jill, Mateus, Julio, Quiñones, Joanne N., Galeano-Herrera, Santiago, Pereira, Leonardo, Burwick, Richard, López-Torres, Luisa, Valencia, Catalina, Berghella, Vincenzo
• Format: Article
• Language: English
• Subjects: Adult; cerclage; Cerclage, Cervical - methods; cervical insufficiency; Cohort Studies; Colombia - epidemiology; Female; Humans; Infant, Newborn; Pregnancy; Premature Birth - epidemiology; Premature Birth - prevention & control; preterm birth; preterm birth prevention; progesterone; Progestins - administration & dosage; progestogen; Retrospective Studies; United States - epidemiology
• ISSN: 2589-9333; 2589-9333
• DOI: 10.1016/j.ajogmf.2024.101351

Both progestogens and cerclage are individually effective in preterm birth prevention in high risk pregnancies. However, national and international guidelines cite a lack of data available to comment on the potential benefit of concurrent progestogen therapy after cerclage has been placed. Studies to date have been small with mixed results regarding benefit of concurrent progestogen with cerclage leaving uncertainty regarding best clinical practice. This study aimed to evaluate whether cerclage with progestogen therapy was superior to cerclage alone in the prevention of spontaneous preterm birth in singleton pregnancies. This is an international retrospective cohort study of singleton pregnancies, without major anomaly or aneuploidy, and with cerclage placed at 10 different institutions in the United States and Colombia from June 2016 to June 2020. Exclusion criteria were lack of documentation regarding whether progestogen was prescribed, unavailable delivery outcome, and pregnancy termination (spontaneous or induced) before 16 weeks’ gestation. The exposure of interest was progestogen use with cerclage placement, which included those who continued to use progestogen or who started progestogen after cerclage. The comparison group consisted of those without progestogen use after cerclage placement, which included those who had no progestogen use during the entire pregnancy or who initiated progestogen and then stopped it after cerclage placement. Progestogen type, cerclage indication, maternal baseline characteristics, and maternal/neonatal outcomes were collected. The primary outcome was spontaneous preterm birth at