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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica


IMPACT FACTOR 2018: 1.361
5-year IMPACT FACTOR: 1.578

CiteScore 2018: 1.29

SCImago Journal Rank (SJR) 2018: 0.522
Source Normalized Impact per Paper (SNIP) 2018: 0.602

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1619-3997
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Volume 37, Issue 5

Issues

A randomized trial of cerclage vs. 17 α-hydroxyprogesterone caproate for treatment of short cervix

Sean M. Keeler
  • Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA, USA
  • Obstetrics and Gynecology, New York University Medical Center, New York, NY, USA
  • Other articles by this author:
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/ Daniel Kiefer / Meredith Rochon / Joanne N. Quinones / Akiva P. Novetsky / Orion Rust
Published Online: 2009-06-03 | DOI: https://doi.org/10.1515/JPM.2009.083

Abstract

Objective: To determine pregnancy outcome in patients with short cervix on transvaginal ultrasound between 16 and 24 weeks' gestation treated with McDonald cerclage compared to weekly intramuscular injections of 17 α-hydroxyprogesterone caproate (17OHP-C).

Methods: From November 2003 through December 2006, asymptomatic, singleton pregnancies were screened with transvaginal ultrasound between 16–24 weeks' gestation. Patients with a cervical length (CL) ≤25 mm were offered enrollment. Patients were randomly assigned to treatment with McDonald cerclage or weekly intramuscular injections of 17OHP-C. The primary outcome was spontaneous preterm birth (PTB) prior to 35 weeks' gestation.

Results: Seventy-nine patients met inclusion criteria; 42 were randomly assigned to the cerclage and 37 to 17OHP-C. Spontaneous PTB prior to 35 weeks' gestation occurred in 16/42 (38.1%) of the cerclage group and in 16/37 (43.2%) of the 17OHP-C group (relative risk, 1.14 95% CI, 0.67, 1.93). A post hoc analysis of patients with a prior PTB showed no difference in spontaneous PTB <35 weeks between groups. A similar analysis of patients with a CL≤15 mm showed a reduction in spontaneous PTB <35 weeks in the cerclage group (relative risk 0.48, 0.24–0.97).

Conclusion: Women with CL ≤25 mm in the second-trimester appear to have similar risks of delivering prior to 35 weeks' gestation when treated with 17OHP-C or McDonald cerclage. However, cerclage may be more effective in preventing spontaneous PTB in women with CL≤15 mm.

Keywords: Cervical length; 17 α-hydroxyprogesterone caproate; spontaneous preterm birth; short cervix

About the article

Corresponding author: Sean M. Keeler, MD Lehigh Valley Health Network 1200 S. Cedar Crest Blvd. Allentown PA 18103 USA Tel.: +1-610-402-1221 Fax: +1-610-402-1328


Received: 2008-10-14

Revised: 2009-02-11

Accepted: 2009-02-16

Published Online: 2009-06-03

Published Online: 2009-06-03

Published in Print: 2009-09-01


Citation Information: Journal of Perinatal Medicine, Volume 37, Issue 5, Pages 473–479, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/JPM.2009.083.

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