Study: Cervical pessary versus vaginal progesterone in women with a singleton pregnancy, a short cervix, and no history of spontaneous preterm birth at less than 34 weeks’ gestation: open label, multicentre, randomised, controlled trial.
Women with a short cervix around 20 weeks of pregnancy are at a higher risk of preterm birth. Preventing premature birth in pregnant women with a short cervix is an important step toward protecting the health of the child. According to research from Amsterdam UMC, in pregnant women with a short cervix around 20 weeks, progesterone (a hormone) is more effective than a cervical pessary in reducing the risk of severe preterm birth. This study was published today in the British Medical Journal.
“This is an important improvement that can contribute to the reduction of preterm births and their associated complications, such as an increased risk of infant mortality and long-term health problems for the child,” says Eva Pajkrt, an obstetrics professor at Amsterdam UMC.
Preterm delivery, defined as a birth before 37 weeks, is still a severe issue with far-reaching implications. Every year, around 13.5 million children around the world are born prematurely. Preterm babies are more likely to suffer from physical and developmental difficulties throughout their lives. Preventing premature birth is thus a top concern at Amsterdam University Medical Center’s obstetrics department.
Reducing extreme Premature Birth
The Amsterdam UMC research team looked into the optimal treatment for women who had a cervical length of less than 25 mm at their 20-week ultrasonography assessment. This study was conducted in 25 centers throughout the Netherlands. Women with a short cervix could be randomly assigned to receive progesterone or a pessary. The findings of this study indicate that progesterone is more beneficial than a pessary in decreasing extreme preterm birth. This study emphasizes the need for assessing the cervix length during the 20-week ultrasound scan and notifying women whose cervix is shorter than 25 mm about the possibility of progesterone medication.
There is no significant difference
For women with a cervical length of 25 mm to 35 mm, there was no significant difference in the number of problems associated with preterm birth between the progesterone group and the group that used a pessary.
“Based on our study, we recommend measuring the length of the cervix of all pregnant women during the 20-week ultrasound. Women with a cervix shorter than 25 mm should be informed about the possibility of treatment with progesterone,” Pajkrt said.
The study’s findings are critical for the healthcare system, since they can help reduce preterm births and their problems. Pajkrt added, “With serious consequences for both the individual and our society.”
More information: Cervical pessary versus vaginal progesterone in women with a singleton pregnancy, a short cervix, and no history of spontaneous preterm birth at less than 34 weeks’ gestation: open label, multicentre, randomised, controlled trial, The BMJ (2024). DOI: 10.1136/bmj-2023-077033
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