Vaginal Progesterone is as Effective as Cervical Cerclage to Prevent Preterm Birth in Women with a Singleton Gestation, Previous Spontaneous Preterm Birth and a Short Cervix: Updated Indirect Comparison Meta-Analysis Academic Article uri icon

abstract

  • Background An indirect comparison meta-analysis published in 2013 reported that both vaginal progesterone and cerclage are equally efficacious for preventing preterm birth and adverse perinatal outcomes in women with a singleton gestation, previous spontaneous preterm birth and a sonographic short cervix. The efficacy of vaginal progesterone has been disputed after publication of the OPPTIMUM study. Objective To compare the efficacy of vaginal progesterone and cerclage in preventing preterm birth and adverse perinatal outcomes in women with a singleton gestation, previous spontaneous preterm birth and a midtrimester sonographic short cervix. Data Sources MEDLINE, EMBASE, LILACS, and CINAHL (from their inception to March 2018); Cochrane databases, bibliographies, and conference proceedings. Study Eligibility Criteria Randomized controlled trials comparing vaginal progesterone with placebo/no treatment or cerclage with no cerclage in women with a singleton gestation, previous spontaneous preterm birth and a sonographic cervical length <25 mm. Study Appraisal and Synthesis Methods Updated systematic review and adjusted indirect comparison meta-analysis of vaginal progesterone versus cerclage using placebo/no cerclage as the common comparator. The primary outcomes were preterm birth <35 weeks of gestation and perinatal mortality. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Results Five trials comparing vaginal progesterone versus placebo (265 women) and 5 comparing cerclage versus no cerclage (504 women) were included. Vaginal progesterone, compared with placebo, significantly reduced the risk of preterm birth <35 and <32 weeks of gestation, composite perinatal morbidity/mortality, neonatal sepsis, composite neonatal morbidity, and admission to the neonatal intensive care unit (RRs from 0.29-0.68). Cerclage, compared with no cerclage, significantly decreased the risk of preterm birth <35, <37, <32, and <28 weeks of gestation, composite perinatal morbidity/mortality, and birthweigth <1500 g (RRs from 0.64-0.70). Adjusted indirect comparison meta-analyses did not show statistically significant differences between vaginal progesterone and cerclage in the reduction of preterm birth or adverse perinatal outcomes. Conclusions Vaginal progesterone and cerclage are equally effective for preventing preterm birth and improving perinatal outcomes in women with a singleton gestation, previous spontaneous preterm birth, and a midtrimester sonographic short cervix. The choice of treatment will depend on adverse events and cost-effectiveness of interventions, and patient/physician’s preferences.

publication date

  • April 7, 2018