Progesterone and cerclage reduce prematurity. the international collaborative for cerclage longitudinal evaluation and research (IC-CLEAR)

To determine if the use of progesterone reduces the risk of spontaneous preterm birth (sPTB) after a cerclage has been placed Retrospective cohort study of singletons managed with cerclage for any indication between 6/2016-8/2020 at 10 sites across the United States and Colombia. Participants with data available regarding progesterone use and delivery outcomes were included. The cohort was divided in those that used any kind of progesterone after cerclage placement and those with no progesterone post-cerclage. Progesterone use included any formulation (vaginal or oral progesterone, intramuscular or subcutaneous 17OHPC). Primary outcome was incidence of sPTB< 37 weeks. Secondary outcomes included sPTB< 34 weeks, NICU admission, birthweight, gestational age at delivery. Chi-square and t-test were used for univariate analysis. Multi-variable bivariate logistic regression with backward selection and ANCOVA were used for adjusted analyses; analyses were adjusted for indication for cerclage as well as baseline characteristics different at p< 0.20. 701 were included. 562 (80%) used any progesterone post-cerclage and 139 (20%) did not. Of those with progesterone use post cerclage, 246 (35%) initiated it before and continued post cerclage and 216 (45%) initiated progesterone post-cerclage. Progesterone formulations used post cerclage included vaginal progesterone (N=246, 35%) 17-OHPC (N=295, 42%). The overall rate of sPTB was 32% (N=223). Baseline characteristics were similar between groups except study site, suture type, and prior PTB history. Progesterone use was associated with reduced rates of sPTB at < 37 weeks aOR (95%CI 0.65 (0.44-0.97), < 34 weeks aOR 0.59 (0.37-0.92) Cox regression analysis demonstrated increased latency to sPTB ( (p=0.0009) Compared to no progesterone, progesterone therapy post-cerclage was associated with a reduced rate of sPTB. Concurrent progesterone use with cerclage placement may improve perinatal outcomesView Large Image Figure ViewerDownload Hi-res image Download (PPT)