Comparative study between cervical cerclage and vaginal progesterone for the prevention of preterm birth in women with a history of preterm birth and a sonographic short cervix: A randomized trial

Objective: This randomized controlled trial aimed to compare cervical cerclage and vaginal progesterone for the prevention of preterm birth with a sonographic short cervix in the mid-trimester, singleton gestation and previous preterm birth. Study design: Women with high-risk factors for preterm birth (history of previous preterm labour/ second trimester loss [>16weeks or <37 weeks gestation], short cervical length (<25mm) on ultrasound at 16 to 24weeks gestation, and Previous prophylactic cervical cerclage) were screened through TVU (Transvaginal Ultrasound) of cervix every two weeks between 14 - 24 weeks. The eligible women with sonographic short cervix <25mm in the mid trimester, singleton gestation and previous spontaneous PTB <37 weeks of gestation were randomized either to cervical cerclage group (McDonald cerclage) or vaginal progesterone group (200mg vaginal progesterone suppository to be inserted at night. Treatment was continued until either delivery, 37 weeks of gestation or development of premature rupture of membranes. Primary outcome measure was PTB <34 weeks gestation. Result: One hundred women were assigned randomly. Both interventions were associated with a statistically significant reduction in the risk of preterm birth <34 weeks of gestation ((p=0.001).Comparing using cervical cerclage and vaginal progesterone, showed that no statistical significant difference in reducing preterm birth or adverse perinatal outcomes. Conclusion: It was concluded that the vaginal progesterone is effective as cervical cerclage in prevention premature labor but its use is preferable in clinical because it's non-invasive technique and less cost. These results should be confirmed by large sample trial.