Abstract
Discussion Forum (0)
Progesterone After Cerclage Does Not Improve the Preterm Birth Rate
INTRODUCTION:
Preterm birth represents a leading cause of neonatal morbidity and mortality. Cerclage and progesterone supplementation are the two most frequently employed interventions to reduce the risk of prematurity. Guidelines for cerclage and progesterone have evolved as conflicting evidence for their use mounts, and combination therapy remains poorly understood. Our objective is to determine whether there is benefit to adjunct progesterone supplementation after cerclage placement.
METHODS:
This is a retrospective cohort review of all individuals who underwent transvaginal cerclage placement at a tertiary medical center between 2005 and 2021. The rate of delivery prior to 37 weeks was compared between participants with and without progesterone supplementation after cerclage. Several secondary maternal and neonatal outcomes were evaluated. Multivariate regression analysis accounted for cerclage indication, use of progesterone prior to cerclage, and other factors that affect prematurity risk.
RESULTS:
Of 451 participants, there were 160 history-indicated, 134 ultrasound-indicated, and 157 examination-indicated cerclages. Overall, 285 (63.2%) received postcerclage progesterone. Progesterone after cerclage did not decrease the rate of preterm delivery (adjusted odds ratio 1.1, 95% CI 0.4–2.6) for any indication of cerclage. Moreover, adjunct progesterone was associated with decreased latency between cerclage placement and delivery (P=<.01).
CONCLUSION:
Prescribing patterns for progesterone after cerclage suggest clinical equipoise. We have found that adjunct progesterone does not decrease the preterm delivery rate and may in fact cause harm by decreasing latency from cerclage to delivery. These data do not support the use of progesterone after cerclage for any indication.
DOI: 10.1097/01.AOG.0000930104.98500.b6
Preterm birth represents a leading cause of neonatal morbidity and mortality. Cerclage and progesterone supplementation are the two most frequently employed interventions to reduce the risk of prematurity. Guidelines for cerclage and progesterone have evolved as conflicting evidence for their use mounts, and combination therapy remains poorly understood. Our objective is to determine whether there is benefit to adjunct progesterone supplementation after cerclage placement.
METHODS:
This is a retrospective cohort review of all individuals who underwent transvaginal cerclage placement at a tertiary medical center between 2005 and 2021. The rate of delivery prior to 37 weeks was compared between participants with and without progesterone supplementation after cerclage. Several secondary maternal and neonatal outcomes were evaluated. Multivariate regression analysis accounted for cerclage indication, use of progesterone prior to cerclage, and other factors that affect prematurity risk.
RESULTS:
Of 451 participants, there were 160 history-indicated, 134 ultrasound-indicated, and 157 examination-indicated cerclages. Overall, 285 (63.2%) received postcerclage progesterone. Progesterone after cerclage did not decrease the rate of preterm delivery (adjusted odds ratio 1.1, 95% CI 0.4–2.6) for any indication of cerclage. Moreover, adjunct progesterone was associated with decreased latency between cerclage placement and delivery (P=<.01).
CONCLUSION:
Prescribing patterns for progesterone after cerclage suggest clinical equipoise. We have found that adjunct progesterone does not decrease the preterm delivery rate and may in fact cause harm by decreasing latency from cerclage to delivery. These data do not support the use of progesterone after cerclage for any indication.
DOI: 10.1097/01.AOG.0000930104.98500.b6
Progesterone After Cerclage Does Not Improve the Preterm Birth Rate
INTRODUCTION:
Preterm birth represents a leading cause of neonatal morbidity and mortality. Cerclage and progesterone supplementation are the two most frequently employed interventions to reduce the risk of prematurity. Guidelines for cerclage and progesterone have evolved as conflicting evidence for their use mounts, and combination therapy remains poorly understood. Our objective is to determine whether there is benefit to adjunct progesterone supplementation after cerclage placement.
METHODS:
This is a retrospective cohort review of all individuals who underwent transvaginal cerclage placement at a tertiary medical center between 2005 and 2021. The rate of delivery prior to 37 weeks was compared between participants with and without progesterone supplementation after cerclage. Several secondary maternal and neonatal outcomes were evaluated. Multivariate regression analysis accounted for cerclage indication, use of progesterone prior to cerclage, and other factors that affect prematurity risk.
RESULTS:
Of 451 participants, there were 160 history-indicated, 134 ultrasound-indicated, and 157 examination-indicated cerclages. Overall, 285 (63.2%) received postcerclage progesterone. Progesterone after cerclage did not decrease the rate of preterm delivery (adjusted odds ratio 1.1, 95% CI 0.4–2.6) for any indication of cerclage. Moreover, adjunct progesterone was associated with decreased latency between cerclage placement and delivery (P=<.01).
CONCLUSION:
Prescribing patterns for progesterone after cerclage suggest clinical equipoise. We have found that adjunct progesterone does not decrease the preterm delivery rate and may in fact cause harm by decreasing latency from cerclage to delivery. These data do not support the use of progesterone after cerclage for any indication.
DOI: 10.1097/01.AOG.0000930104.98500.b6
Preterm birth represents a leading cause of neonatal morbidity and mortality. Cerclage and progesterone supplementation are the two most frequently employed interventions to reduce the risk of prematurity. Guidelines for cerclage and progesterone have evolved as conflicting evidence for their use mounts, and combination therapy remains poorly understood. Our objective is to determine whether there is benefit to adjunct progesterone supplementation after cerclage placement.
METHODS:
This is a retrospective cohort review of all individuals who underwent transvaginal cerclage placement at a tertiary medical center between 2005 and 2021. The rate of delivery prior to 37 weeks was compared between participants with and without progesterone supplementation after cerclage. Several secondary maternal and neonatal outcomes were evaluated. Multivariate regression analysis accounted for cerclage indication, use of progesterone prior to cerclage, and other factors that affect prematurity risk.
RESULTS:
Of 451 participants, there were 160 history-indicated, 134 ultrasound-indicated, and 157 examination-indicated cerclages. Overall, 285 (63.2%) received postcerclage progesterone. Progesterone after cerclage did not decrease the rate of preterm delivery (adjusted odds ratio 1.1, 95% CI 0.4–2.6) for any indication of cerclage. Moreover, adjunct progesterone was associated with decreased latency between cerclage placement and delivery (P=<.01).
CONCLUSION:
Prescribing patterns for progesterone after cerclage suggest clinical equipoise. We have found that adjunct progesterone does not decrease the preterm delivery rate and may in fact cause harm by decreasing latency from cerclage to delivery. These data do not support the use of progesterone after cerclage for any indication.
DOI: 10.1097/01.AOG.0000930104.98500.b6
Progesterone after cerclage does not improve the preterm birth rate
Lauren Sayres
Affiliations:
null
null
Abstract
Discussion Forum (0)
Progesterone After Cerclage Does Not Improve the Preterm Birth Rate
INTRODUCTION:
Preterm birth represents a leading cause of neonatal morbidity and mortality. Cerclage and progesterone supplementation are the two most frequently employed interventions to reduce the risk of prematurity. Guidelines for cerclage and progesterone have evolved as conflicting evidence for their use mounts, and combination therapy remains poorly understood. Our objective is to determine whether there is benefit to adjunct progesterone supplementation after cerclage placement.
METHODS:
This is a retrospective cohort review of all individuals who underwent transvaginal cerclage placement at a tertiary medical center between 2005 and 2021. The rate of delivery prior to 37 weeks was compared between participants with and without progesterone supplementation after cerclage. Several secondary maternal and neonatal outcomes were evaluated. Multivariate regression analysis accounted for cerclage indication, use of progesterone prior to cerclage, and other factors that affect prematurity risk.
RESULTS:
Of 451 participants, there were 160 history-indicated, 134 ultrasound-indicated, and 157 examination-indicated cerclages. Overall, 285 (63.2%) received postcerclage progesterone. Progesterone after cerclage did not decrease the rate of preterm delivery (adjusted odds ratio 1.1, 95% CI 0.4–2.6) for any indication of cerclage. Moreover, adjunct progesterone was associated with decreased latency between cerclage placement and delivery (P=<.01).
CONCLUSION:
Prescribing patterns for progesterone after cerclage suggest clinical equipoise. We have found that adjunct progesterone does not decrease the preterm delivery rate and may in fact cause harm by decreasing latency from cerclage to delivery. These data do not support the use of progesterone after cerclage for any indication.
DOI: 10.1097/01.AOG.0000930104.98500.b6
Preterm birth represents a leading cause of neonatal morbidity and mortality. Cerclage and progesterone supplementation are the two most frequently employed interventions to reduce the risk of prematurity. Guidelines for cerclage and progesterone have evolved as conflicting evidence for their use mounts, and combination therapy remains poorly understood. Our objective is to determine whether there is benefit to adjunct progesterone supplementation after cerclage placement.
METHODS:
This is a retrospective cohort review of all individuals who underwent transvaginal cerclage placement at a tertiary medical center between 2005 and 2021. The rate of delivery prior to 37 weeks was compared between participants with and without progesterone supplementation after cerclage. Several secondary maternal and neonatal outcomes were evaluated. Multivariate regression analysis accounted for cerclage indication, use of progesterone prior to cerclage, and other factors that affect prematurity risk.
RESULTS:
Of 451 participants, there were 160 history-indicated, 134 ultrasound-indicated, and 157 examination-indicated cerclages. Overall, 285 (63.2%) received postcerclage progesterone. Progesterone after cerclage did not decrease the rate of preterm delivery (adjusted odds ratio 1.1, 95% CI 0.4–2.6) for any indication of cerclage. Moreover, adjunct progesterone was associated with decreased latency between cerclage placement and delivery (P=<.01).
CONCLUSION:
Prescribing patterns for progesterone after cerclage suggest clinical equipoise. We have found that adjunct progesterone does not decrease the preterm delivery rate and may in fact cause harm by decreasing latency from cerclage to delivery. These data do not support the use of progesterone after cerclage for any indication.
DOI: 10.1097/01.AOG.0000930104.98500.b6
Progesterone After Cerclage Does Not Improve the Preterm Birth Rate
INTRODUCTION:
Preterm birth represents a leading cause of neonatal morbidity and mortality. Cerclage and progesterone supplementation are the two most frequently employed interventions to reduce the risk of prematurity. Guidelines for cerclage and progesterone have evolved as conflicting evidence for their use mounts, and combination therapy remains poorly understood. Our objective is to determine whether there is benefit to adjunct progesterone supplementation after cerclage placement.
METHODS:
This is a retrospective cohort review of all individuals who underwent transvaginal cerclage placement at a tertiary medical center between 2005 and 2021. The rate of delivery prior to 37 weeks was compared between participants with and without progesterone supplementation after cerclage. Several secondary maternal and neonatal outcomes were evaluated. Multivariate regression analysis accounted for cerclage indication, use of progesterone prior to cerclage, and other factors that affect prematurity risk.
RESULTS:
Of 451 participants, there were 160 history-indicated, 134 ultrasound-indicated, and 157 examination-indicated cerclages. Overall, 285 (63.2%) received postcerclage progesterone. Progesterone after cerclage did not decrease the rate of preterm delivery (adjusted odds ratio 1.1, 95% CI 0.4–2.6) for any indication of cerclage. Moreover, adjunct progesterone was associated with decreased latency between cerclage placement and delivery (P=<.01).
CONCLUSION:
Prescribing patterns for progesterone after cerclage suggest clinical equipoise. We have found that adjunct progesterone does not decrease the preterm delivery rate and may in fact cause harm by decreasing latency from cerclage to delivery. These data do not support the use of progesterone after cerclage for any indication.
DOI: 10.1097/01.AOG.0000930104.98500.b6
Preterm birth represents a leading cause of neonatal morbidity and mortality. Cerclage and progesterone supplementation are the two most frequently employed interventions to reduce the risk of prematurity. Guidelines for cerclage and progesterone have evolved as conflicting evidence for their use mounts, and combination therapy remains poorly understood. Our objective is to determine whether there is benefit to adjunct progesterone supplementation after cerclage placement.
METHODS:
This is a retrospective cohort review of all individuals who underwent transvaginal cerclage placement at a tertiary medical center between 2005 and 2021. The rate of delivery prior to 37 weeks was compared between participants with and without progesterone supplementation after cerclage. Several secondary maternal and neonatal outcomes were evaluated. Multivariate regression analysis accounted for cerclage indication, use of progesterone prior to cerclage, and other factors that affect prematurity risk.
RESULTS:
Of 451 participants, there were 160 history-indicated, 134 ultrasound-indicated, and 157 examination-indicated cerclages. Overall, 285 (63.2%) received postcerclage progesterone. Progesterone after cerclage did not decrease the rate of preterm delivery (adjusted odds ratio 1.1, 95% CI 0.4–2.6) for any indication of cerclage. Moreover, adjunct progesterone was associated with decreased latency between cerclage placement and delivery (P=<.01).
CONCLUSION:
Prescribing patterns for progesterone after cerclage suggest clinical equipoise. We have found that adjunct progesterone does not decrease the preterm delivery rate and may in fact cause harm by decreasing latency from cerclage to delivery. These data do not support the use of progesterone after cerclage for any indication.
DOI: 10.1097/01.AOG.0000930104.98500.b6
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