A combined efficacy of cervical cerclage and vaginal progesterone use in a pregnant woman with sonographic short cervix and its outcome- an observational study in a tertiary care centre
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20251237Keywords:
Vaginal progesterone, Respiratory distress syndrome, Preterm birth, Neonatal intensive care unit, Cervical cerclage, Cervical incompetenceAbstract
Background: Combined use of cervical cerclage procedure and vaginal progesterone administration in a women with sonographic short cervix as a treatment of cervical insufficiency is the most efficacious and safest intervention used to prevent preterm birth and neonatal morbidity/mortality.
Methods: This prospective observational study was conducted in Government Villupuram Medical College and Hospital, Villupuram over a period of June, 2022- July, 2024. This study includes a observational review of 133 patients in a tertiary care centre, who undergone transvaginal cervical cerclage procedures and vaginal progesterone administration over a period of 2 years.
Results: Out of 133 cases, only 100 cases were included in this study, remaining cases were dropped due to incomplete follow up and abortions. Overall efficacy of cervical cerclage and vaginal progesterone combination were expressed in terms of sensitivity as 86% which indicates the reduced incidence of preterm birth by improving latency period in terms of gestational age at the time of delivery as well as by decreasing the incidence of cervical dilatation prior to labour in our study group.
Conclusions: Combination of cervical cerclage and vaginal progesterone administration in a pregnant woman with a sonographic short cervix had a beneficial impact in reducing preterm birth and significant improvement in perinatal outcomes.
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References
Simsek Y, Yüksel B, Celen S, Ozyer S, Ozdemir I, Kaya A, et al. Prophylactic and emergency cervical cerclage procedures. J Turk Ger Gynecol Assoc. 2021;22:22-8. DOI: https://doi.org/10.4274/jtgga.galenos.2020.2019.0183
Fahmy M, El-Masry R, Gaber H, Soliman A, Mahmoud S, Zaki T, et al. Vaginal progesterone versus cervical cerclage. Al-Azhar Int Med J. 2021;2(8).
ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet Gynecol. 2014;123(2 Pt 1):372-9. DOI: https://doi.org/10.1097/01.AOG.0000443276.68274.cc
Suhag A, Seligman N, Giraldo-Isaza M, Berghella V. Pre-pregnancy body mass index (BMI) and cerclage success. J Matern Fetal Neonatal Med. 2016;29:368-75. DOI: https://doi.org/10.3109/14767058.2015.1006622
Naim RM, Samie MA, Elkatatny HH. Vaginal progesterone versus cervical cerclage or both for prevention of preterm delivery. Egypt J Hosp Med. 2018;71(5):3206-10.
Berghella V, Mackeen AD. Cervical length screening with ultrasound-indicated cerclage compared with history-indicated cerclage for prevention of preterm birth: a meta-analysis. Obstet Gynecol. 2011;118:148-55. DOI: https://doi.org/10.1097/AOG.0b013e31821fd5b0
Brown JA, Pearson AW, Veillon EW, Rust OA, Chauhan SP, Magann EF, et al. History- or ultrasound-based cerclage placement and adverse perinatal outcomes. J Reprod Med. 2011;56:385-92.
Liddiard A, Bhattacharya S, Crichton L. Elective and emergency cervical cerclage and immediate pregnancy outcomes: a retrospective observational study. JRSM Short Rep. 2011;2:91. DOI: https://doi.org/10.1258/shorts.2011.011043
Shor S, Zimerman A, Maymon R, Glezerman M, Rabinerson D, Dreazen E, et al. Combined therapy with vaginal progesterone, Arabian cervical pessary and cervical cerclage to prevent preterm delivery in high-risk women. J Matern Fetal Neonatal Med. 2019;19:1-5.
Alfirevic Z, Owen J, Carreras Moratonas E, Sharp AN, Szychowski JM, Hassan SS, et al. Vaginal progesterone, cerclage or cervical pessary for preventing preterm birth in asymptomatic singleton pregnant women with a history of preterm birth and a sonographic short cervix. Ultrasound Obstet Gynecol. 2013;41(2):146-51. DOI: https://doi.org/10.1002/uog.12300
O’Brien JM, Hill AL, Barton JR. Funnelling to the stitch: an informative ultrasonographic finding after cervical cerclage. Ultrasound Obstet Gynecol. 2002;20(3):252-5. DOI: https://doi.org/10.1046/j.1469-0705.2002.00788.x
Celen S, Simsek Y, Ozyer S, Doganay M, Sahin G, Korkmaz C, et al. Effectiveness of emergency cervical cerclage in patients with cervical dilatation in the second trimester. Clin Exp Obstet Gynecol. 2011;38(2):131-3.
Romero R, Nicolaides K, Conde‐Agudelo A, O’Brien JM, Cetingoz E, Da Fonseca E, et al. Vaginal progesterone decreases preterm birth ≤34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study. Ultrasound Obstet Gynecol. 2016;48(3):308-17. DOI: https://doi.org/10.1002/uog.15953
Norman JE, Marlow N, Messow CM, Shennan A, Bennett PR, Thornton S, et al. Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet. 2016;387(10033):2106-16. DOI: https://doi.org/10.1016/S0140-6736(16)00350-0
Crowther CA, Ashwood P, McPhee AJ, Willson K, Wills A, Doyle LW, et al. Vaginal progesterone pessaries for pregnant women with a previous preterm birth to prevent neonatal respiratory distress syndrome (the PROGRESS Study): a multicentre, randomised, placebo-controlled trial. PLoS Med. 2017;14(9):e1002390. DOI: https://doi.org/10.1371/journal.pmed.1002390
Jarde A, Lutsiv O, Beyene J, McDonald SD, Barrett J, Saito S, et al. Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: an updated systematic review and network meta-analysis. BJOG. 2019;126(5):556-67. DOI: https://doi.org/10.1111/1471-0528.15566