期刊
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
卷 208, 期 1, 页码 -出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.ajog.2012.10.877
关键词
birthweight; cervix; neonatal intensive care unit; perinatal mortality; perinatal morbidity; premature; prematurity; progestin; 17 alpha-hydroxyprogesterone caproate; 17P
资金
- Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institutes of Health
- Department of Health and Human Services, Bethesda, MD
- Columbia Laboratories, Inc
- Watson Pharmaceuticals
OBJECTIVE: No randomized controlled trial has compared vaginal progesterone and cervical cerclage directly for the prevention of preterm birth in women with a sonographic short cervix in the mid trimester, singleton gestation, and previous spontaneous preterm birth. We performed an indirect comparison of vaginal progesterone vs cerclage using placebo/no cerclage as the common comparator. STUDY DESIGN: Adjusted indirect metaanalysis of randomized controlled trials. RESULTS: Four studies that evaluated vaginal progesterone vs placebo (158 patients) and 5 studies that evaluated cerclage vs no cerclage (504 patients) were included. Both interventions were associated with a statistically significant reduction in the risk of preterm birth at <32 weeks of gestation and composite perinatal morbidity and mortality compared with placebo/no cerclage. Adjusted indirect metaanalyses did not show statistically significant differences between vaginal progesterone and cerclage in the reduction of preterm birth or adverse perinatal outcomes. CONCLUSION: Based on state-of-the-art methods for indirect comparisons, either vaginal progesterone or cerclage are equally efficacious in the prevention of preterm birth in women with a sonographic short cervix in the mid trimester, singleton gestation, and previous preterm birth. Selection of the optimal treatment needs to consider adverse events, cost and patient/clinician preferences.
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