• Agustin Conde-Agudelo, Roberto Romero, Kypros Nicolaides, Tinnakorn Chaiworapongsa, John M O'Brien, Elcin Cetingoz, Eduardo da Fonseca, George Creasy, Priya Soma-Pillay, Shalini Fusey, Cetin Cam, Zarko Alfirevic, and Sonia S Hassan.
• Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA.
• Am. J. Obstet. Gynecol. 2013 Jan 1; 208 (1): 42.e1-42.e18.

ObjectiveNo 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 DesignAdjusted indirect metaanalysis of randomized controlled trials.ResultsFour 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.ConclusionBased 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.Copyright © 2013. Published by Mosby, Inc.

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