premature labour - prophylactic vaginal progesterone and prophylactic cervical cerclage

Preterm birth causes significant neonatal morbidity and mortality, as well as long-term disability.

• therefore strategies for preventing preterm birth are important
• both prophylactic cervical cerclage and prophylactic vaginal progesterone are effective in preventing or delaying preterm birth in women with a short cervix and a history of spontaneous preterm birth (up to 34+0 weeks of pregnancy) or mid-trimester loss (from 16+0 weeks of pregnancy onwards)
  • the choice as to which treatment is best for each woman will depend on her individual preferences and circumstances, and women should be given information as part of shared decision making

Prophylactic vaginal progesterone and prophylactic cervical cerclage

• a choice of prophylactic vaginal progesterone or prophylactic cervical cerclage should be offered to women who have both:
  
  
  • a history of spontaneous preterm birth (up to 34+0 weeks of pregnancy) or midtrimester loss (from 16+0 weeks of pregnancy onwards) and
    
    
  • results from a transvaginal ultrasound scan carried out between 16+0 and 24+0 weeks of pregnancy that show a cervical length of 25 mm or less

Consider prophylactic vaginal progesterone for women who have either:

• a history of spontaneous preterm birth (up to 34+0 weeks of pregnancy) or midtrimester loss (from 16+0 weeks of pregnancy onwards) or
  
  
• results from a transvaginal ultrasound scan carried out between 16+0 and 24+0 weeks of pregnancy that show a cervical length of 25mm or less

When using vaginal progesterone, start treatment between 16+0 and 24+0 weeks of pregnancy and continue until at least 34 weeks.

Consider prophylactic cervical cerclage for women when results of a transvaginal ultrasound scan carried out between 16+0 and 24+0 weeks of pregnancy show a cervical length of 25 mm or less, and who have had either:

• preterm prelabour rupture of membranes (P-PROM) in a previous pregnancy or
  
  
• a history of cervical trauma

If prophylactic cervical cerclage is used, ensure that a plan is in place for removal of the suture.

Reference:

• NICE (June 2022).Preterm labour and birth

Last edited 06/2022