Vaginal progesterone combined with cervical pessary – a further chance for pregnancies at risk for spontaneous preterm birth?

N Stricker; R Khatib; I Kyvernitakis; N Timmesfeld; B Arabin

doi:10.1055/s-0035-1566556

Zeitschrift für Geburtshilfe und Neonatologie, Inhaltsverzeichnis

Vaginal progesterone combined with cervical pessary – a further chance for pregnancies at risk for spontaneous preterm birth?

N Stricker ¹, R Khatib ¹, I Kyvernitakis ¹, N Timmesfeld ², B Arabin ¹

¹Philipps-University Marburg, Department of Obstetrics and Gynecology, Marburg, Germany
²Philipps-University Marburg, Department of Medical Biometry, Marburg, Germany

Abstract

Objective: The aim of this pilot study was to evaluate whether vaginal progesterone (VP) improves the effect of cervical pessary (CP) when added in singleton pregnancies with short cervical length (CL).

Methods: Up to 2011, a CP was the standard procedure to treat risk patients with a history of spontaneous preterm birth (SPB) and/or conization with a CL < 10th centile and screening patients with a CL< 3 rd centile with a CP. After the publication of Hassan et al. (2011), 200 mg VP were additionally applied in these patients (CPVP). Risk patients (n = 55) were treated from the 1st trimester onwards, patients of the screening population in the 2nd and early 3 rd trimester (n = 61). Primary outcome was the rate of SPB < 34 weeks. Secondary outcomes were SPB rates < 28 weeks, < 32 weeks and < 37 weeks, days of prolongation, combined poor neonatal outcome and days of neonatal admission.

Results: Delivery < 34 weeks occurred in 16/53 patients (30.2%) with both, CP and VP compared to 15/63 patients (23.8%) treated with CP only (p = 0.736). Delivery < 37 weeks were observed in 22/53 pregnancies (41.6%) treated with CP and VP compared to 26/63 pregnancies (41.3%) treated with CP only (p = 0.593). The mean gestational age at delivery was 36 + 1 weeks in both groups (p = 0.72). The composite poor outcome was 15.9% (CP) versus 15.1% (CP+VP) (p = 0.349); 11 neonates (20.8%) of mothers treated with both, CP and VP spent 44 (8 – 124) days (mean and range), 15 neonates (23.8%) of the CP group spent 61 (16 – 142) days on the neonatal intensive care unit (NICU) (p < 0.001).

Conclusion: Additional VP could not prolong pregnancy or prevent any SPB rate compared to CP alone. Nevertheless, neonates of mothers with both, CP and VP, spent fewer days on the NICU. Even though short-term neonatal outcome might be in favor of VP added to CP, long-term outcome is more essential and still has to be critically evaluated in all infants whose mothers have been treated with progesterone.