Adjunctive Therapies to Cerclage for the Prevention of Preterm Birth: A Systematic Review

Table 1

Studies reporting the use of progesterone as an adjunct to cerclage.

Study	Design	Sample size	Documented average; cervical length (mm)	Mean gestational age (weeks) cerclage	Cerclage type	Progesterone type	Total duration of progesterone therapy (weeks)	Gestational age (weeks) delivery	Outcome	Overall rate of PTB
Sherman 1966, [2]	Observational cohort*	33/540	n/a	Variable	Both	17-𝛼OHPC IM	Variable to 36	39.3	LB	n/a
Vitoratos et al., 1996 [3]	Prospective cohort	8/18	n/a	14-15	Shirodkar	OHP; IM^†	Preoperative one dose	>37	PTB < 37 wga	6% (<37)^††
Zakut and Lanciano, 1981 [4]	Retrospective cohort	30/60	14 ± 4.5	14.6 ± 2.83	Both	17-𝛼OHPC IM	15	n/a	PTB < 24 wga; hospitalization; BW; Apgar score	13.3% (<24)
Berghella et al., 2010 [5]	Retrospective cohort	47/148	19.0	18.9	McDonald	17-𝛼OHPC; IM	From 16 to 36	Not reported	PTB < 37 wga; PTB < 35 wga; PTB < 32 wga; PTB < 28 wga; PTB < 24 wga; PM	49% (<37); 30% (<35); 17% (<32); 9% (<28); 4% (<24)
Rafael et al., 2011 [6]	Retrospective cohort	15/58	18 (12–22)	21 (16–22)	n/a	17-𝛼OHPC IM	From 16–20 to 36	35 (27-28)	PTB < 35 wga; PTB < 32 wga; PTB < 28 wga; BW	40% (<35); 33.3% (<32); 33.3% (<28)
Rebarber et al., 2008 [7]	Retrospective cohort	232/1882	n/a	n/a	n/a	17-𝛼OHPC IM	13.5 ± 5	35.4 ± 4.7	PTB < 37 wga; PTB < 35 wga; PTB < 32 wga	40.5% (<37); 25.9% (<32); 13.4% (<32)

n/a: not available, 17-𝛼OHPC: 17-alpha-hydroxyprogesterone acetate, IM: intramuscular, wga: weeks gestational age, PTB: preterm birth, LB: live birth, BW: birth weight, and PM: perinatal death (stillbirth or postnatal death prior to hospital discharge).
∗Unable to specify based on the review of an article whether the observational study was prospective or retrospective in nature.
†This agent was reported as hydroxyprogesterone hexanoate.
††Did not specify whether PTB was in progesterone plus cerclage treatment group.