Progesterone versus cerclaje versus pessary in pregnant women with sonographic short cervix?

C.A. Coroleucă, M. Dimitriu, R. Bohîlțea, I. Popescu, A.C. Ionescu

Rezumat: Introduction. Premature birth is the leading cause of perinatal morbidity and mortality and its prevention is a priority for maternal-fetal medicine. Our paper presents an analysis of the pregnancy outcome in patients diagnosed with a sonographic short cervix after treatment by three different methods: progesterone, cervical cerclage and vaginal pessary. Methods. We selected representative articles from literature and analyzed the pregnancy outcome in women diagnosed with a short cervix by ultrasound in the second trimester and treated with progesterone, cerclage cervical and vaginal pessary. Results. Ultrasound diagnosis of a short cervix is the most important sign that predicts premature birth. Progesterone administered by vaginal route (in the form of 200 mg tablets or 90 mg gel) was associated with a statistically significant reduction in the incidence of preterm birth and perinatal morbidity and mortality. Cervical cerclage and vaginal pessary reduce the rate of premature births only in certain cases and there is no significant difference between the treatment with progesterone and cerclage/pessary to prevent prematurity. Conclusions. In singleton pregnancy with a short cervix, without obstetrical history of premature births, progesterone reduces the incidence of preterm birth and neonatal morbidity and mortality. In twin pregnancy with a short cervix, cerclage is inefficient for preventing preterm birth and progesterone may be effective to improve neonatal outcome. Vaginal pessary is inefficient in reducing premature birth rates both for singleton and twin pregnancies.
Cuvinte cheie: short cervix sonographic, cervical cerclage, pessary, progesteron.