Cerclage for the prevention of preterm birth in high risk women receiving intramuscular 17-α-hydroxyprogesterone caproate

Jeff M. Szychowski, Vincenzo Berghella, John Owen, Gary Hankins, Jay D. Iams, Jeanne S. Sheffield, Annette Perez-Delboy, Deborah A. Wing, Edwin R. Guzman

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: To assess cerclage benefit in women with short cervix also receiving 17-α-hydroxyprogesterone caproate (17P) to prevent recurrent preterm birth (PTB). Methods: Secondary analysis of a multicenter trial of ultrasound-indicated cerclage for shortened cervical length (CL). Women with prior spontaneous PTB at 16-33 6/7 weeks, singleton gestation and CL < 25-mm between 16 and 22 6/7 weeks were counseled on use of 17P and randomized to cerclage or no cerclage. Outcomes of women who received 17P were analyzed by randomization group. Primary outcome was PTB < 35 weeks. Results: 99 women received 17P: 47 cerclage; 52 no cerclage. Rates of PTB < 35 weeks were similar, 30% for cerclage and 38% for no cerclage (aOR 0.64 (0.27-1.52)). In women with CL < 15-mm, PTB < 35 weeks was reduced for the cerclage group (17% vs. 75%, p = 0.02). However, this difference was nullified after controlling for total progesterone doses received (p = 0.40). Conclusions: Cerclage was shown not to offer additional benefit for the prevention of recurrent PTB in women with short CL < 25-mm receiving 17P, but the sample size is insufficient for a definite conclusion given the 36% nonsignificant decrease in the odds of PTB < 35 weeks. Cerclage may further offer substantial benefit to women with very short CL < 15-mm and further study is needed.

Original languageEnglish (US)
Pages (from-to)2686-2689
Number of pages4
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume25
Issue number12
DOIs
StatePublished - Dec 2012

Fingerprint

17-alpha-Hydroxyprogesterone
Premature Birth
Cervical Cerclage
Random Allocation
17-alpha-hydroxy-progesterone caproate
Cervix Uteri
Sample Size
Multicenter Studies
Progesterone
Pregnancy

Keywords

  • Cerclage
  • Preterm birth
  • Progesterone
  • Short cervical length

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Cerclage for the prevention of preterm birth in high risk women receiving intramuscular 17-α-hydroxyprogesterone caproate. / Szychowski, Jeff M.; Berghella, Vincenzo; Owen, John; Hankins, Gary; Iams, Jay D.; Sheffield, Jeanne S.; Perez-Delboy, Annette; Wing, Deborah A.; Guzman, Edwin R.

In: Journal of Maternal-Fetal and Neonatal Medicine, Vol. 25, No. 12, 12.2012, p. 2686-2689.

Research output: Contribution to journalArticle

Szychowski, JM, Berghella, V, Owen, J, Hankins, G, Iams, JD, Sheffield, JS, Perez-Delboy, A, Wing, DA & Guzman, ER 2012, 'Cerclage for the prevention of preterm birth in high risk women receiving intramuscular 17-α-hydroxyprogesterone caproate', Journal of Maternal-Fetal and Neonatal Medicine, vol. 25, no. 12, pp. 2686-2689. https://doi.org/10.3109/14767058.2012.717128
Szychowski, Jeff M. ; Berghella, Vincenzo ; Owen, John ; Hankins, Gary ; Iams, Jay D. ; Sheffield, Jeanne S. ; Perez-Delboy, Annette ; Wing, Deborah A. ; Guzman, Edwin R. / Cerclage for the prevention of preterm birth in high risk women receiving intramuscular 17-α-hydroxyprogesterone caproate. In: Journal of Maternal-Fetal and Neonatal Medicine. 2012 ; Vol. 25, No. 12. pp. 2686-2689.
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abstract = "Objective: To assess cerclage benefit in women with short cervix also receiving 17-α-hydroxyprogesterone caproate (17P) to prevent recurrent preterm birth (PTB). Methods: Secondary analysis of a multicenter trial of ultrasound-indicated cerclage for shortened cervical length (CL). Women with prior spontaneous PTB at 16-33 6/7 weeks, singleton gestation and CL < 25-mm between 16 and 22 6/7 weeks were counseled on use of 17P and randomized to cerclage or no cerclage. Outcomes of women who received 17P were analyzed by randomization group. Primary outcome was PTB < 35 weeks. Results: 99 women received 17P: 47 cerclage; 52 no cerclage. Rates of PTB < 35 weeks were similar, 30{\%} for cerclage and 38{\%} for no cerclage (aOR 0.64 (0.27-1.52)). In women with CL < 15-mm, PTB < 35 weeks was reduced for the cerclage group (17{\%} vs. 75{\%}, p = 0.02). However, this difference was nullified after controlling for total progesterone doses received (p = 0.40). Conclusions: Cerclage was shown not to offer additional benefit for the prevention of recurrent PTB in women with short CL < 25-mm receiving 17P, but the sample size is insufficient for a definite conclusion given the 36{\%} nonsignificant decrease in the odds of PTB < 35 weeks. Cerclage may further offer substantial benefit to women with very short CL < 15-mm and further study is needed.",
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AU - Owen, John

AU - Hankins, Gary

AU - Iams, Jay D.

AU - Sheffield, Jeanne S.

AU - Perez-Delboy, Annette

AU - Wing, Deborah A.

AU - Guzman, Edwin R.

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N2 - Objective: To assess cerclage benefit in women with short cervix also receiving 17-α-hydroxyprogesterone caproate (17P) to prevent recurrent preterm birth (PTB). Methods: Secondary analysis of a multicenter trial of ultrasound-indicated cerclage for shortened cervical length (CL). Women with prior spontaneous PTB at 16-33 6/7 weeks, singleton gestation and CL < 25-mm between 16 and 22 6/7 weeks were counseled on use of 17P and randomized to cerclage or no cerclage. Outcomes of women who received 17P were analyzed by randomization group. Primary outcome was PTB < 35 weeks. Results: 99 women received 17P: 47 cerclage; 52 no cerclage. Rates of PTB < 35 weeks were similar, 30% for cerclage and 38% for no cerclage (aOR 0.64 (0.27-1.52)). In women with CL < 15-mm, PTB < 35 weeks was reduced for the cerclage group (17% vs. 75%, p = 0.02). However, this difference was nullified after controlling for total progesterone doses received (p = 0.40). Conclusions: Cerclage was shown not to offer additional benefit for the prevention of recurrent PTB in women with short CL < 25-mm receiving 17P, but the sample size is insufficient for a definite conclusion given the 36% nonsignificant decrease in the odds of PTB < 35 weeks. Cerclage may further offer substantial benefit to women with very short CL < 15-mm and further study is needed.

AB - Objective: To assess cerclage benefit in women with short cervix also receiving 17-α-hydroxyprogesterone caproate (17P) to prevent recurrent preterm birth (PTB). Methods: Secondary analysis of a multicenter trial of ultrasound-indicated cerclage for shortened cervical length (CL). Women with prior spontaneous PTB at 16-33 6/7 weeks, singleton gestation and CL < 25-mm between 16 and 22 6/7 weeks were counseled on use of 17P and randomized to cerclage or no cerclage. Outcomes of women who received 17P were analyzed by randomization group. Primary outcome was PTB < 35 weeks. Results: 99 women received 17P: 47 cerclage; 52 no cerclage. Rates of PTB < 35 weeks were similar, 30% for cerclage and 38% for no cerclage (aOR 0.64 (0.27-1.52)). In women with CL < 15-mm, PTB < 35 weeks was reduced for the cerclage group (17% vs. 75%, p = 0.02). However, this difference was nullified after controlling for total progesterone doses received (p = 0.40). Conclusions: Cerclage was shown not to offer additional benefit for the prevention of recurrent PTB in women with short CL < 25-mm receiving 17P, but the sample size is insufficient for a definite conclusion given the 36% nonsignificant decrease in the odds of PTB < 35 weeks. Cerclage may further offer substantial benefit to women with very short CL < 15-mm and further study is needed.

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KW - Progesterone

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