CERCLAGE AND PROGESTERONE, PTB PREVENTION

Question 1

scenarios where cerclage alone has evidence for ptb prevention? (6)

Answer 1

1. 3 or more previous PTB or second trimester losses
2. CVL <10mm (high or low risk population)
3. cervical dilatation and effacement with membranes beyond external os
4. previous radical cervical surgery (trachelectomy)
5. CVL 10-25mm, stable length (high or low risk)
6. CVL >25mm, high risk population.

Question 2

Studies investigating cerclage in context of CVL <10mm or progressive shortening after progesterone started?

Answer 2

Enakpene 2018
Souka 2020
Berghella 2017

Question 3

Studies supporting progesterone use for high risk population (previous PTB) and unknown CVL?

Answer 3

Fonesca 2003

Cochrane 2013

Question 4

Study suggesting vaginal progesterone equal in efficacy to cerclage with lest complications in context of previous PTB and CVL <25mm?

Answer 4

Conde-Aguedelo 2018

Endorsed by RANZCOG

Question 5

No previous PTB, CVL 21mm. Progesterone started. Trigger for cerclage?

Answer 5

progressive shortening

Enakpene 2018

Question 6

Indication for immediate cerclage in low risk woman?

Answer 6

CVL <10mm

Question 7

Question of Enakpene 2018 study regarding preterm birth prevention?

Answer 7

Is cerclage +progesterone or progesterone alone better at PTB prevention if CVL <10mm?

cerclage + prog = 34+3
progesterone = 27+2
Lower rate of sPTB in cerclage group.

Question 8

Rate of sPTB <32 weeks in women with CVL <10mm treated with cerclage vs. progesterone?

Answer 8

20% cerclage
45% prog

Souka 2020

Question 9

Risk ratio of Berghella 2017 study of PTB <35/40 with CVL <10mm and cerclage vs. no cerclage?

Answer 9

RR 0.68.