A randomized trial of cerclage vs. 17 α-hydroxyprogesterone caproate for treatment of short cervix
| Autor: | Meredith Rochon, Orion A. Rust, Joanne N. Quiñones, Daniel G. Kiefer, Akiva P. Novetsky, Sean M. Keeler |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
medicine.medical_specialty Randomization education Asymptomatic Injections Intramuscular law.invention Young Adult Obstetric Labor Premature Randomized controlled trial law Pregnancy Risk Factors 17 alpha-Hydroxyprogesterone Caproate medicine Hydroxyprogesterones Humans Neonatology Cerclage Cervical Gynecology business.industry Obstetrics Infant Newborn Pregnancy Outcome Obstetrics and Gynecology medicine.disease Cervical Length Measurement Pregnancy Trimester Second Pediatrics Perinatology and Child Health Gestation Female Uterine Cervical Incompetence medicine.symptom business Hydroxyprogesterone caproate medicine.drug |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
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