Should phenotype of previous preterm birth influence management of women with short cervix in subsequent pregnancy? Comparison of vaginal progesterone and Arabin pessary
Care, A. (Liverpool Women's Hospital)
Muller-Myhsok, B. (Max Planck Institute of Psychiatry)
Olearo, E. (University of Turin)
Todros, T. (University of Turin)
Caradeux, J. (Clínica Dávila)
Goya, M (María del Mar) (Hospital Universitari Vall d'Hebron)
Palacio, M. (Centro de Investigación Biomédica en Red de Enfermedades Raras)
Carreras Moratonas, Elena (Hospital Universitari Vall d'Hebron)
Alfirevic, Z. (Liverpool Women's Hospital)
Universitat Autònoma de Barcelona

Fecha:	2019
Resumen:	Objective: To investigate whether the classification of a previous spontaneous preterm birth (sPTB) as preterm labor (PTL) with intact membranes (IM) or as preterm prelabor rupture of membranes (PPROM) impacts the efficacy of cervical pessary or vaginal progesterone for prevention of sPTB in pregnant women with short cervix on transvaginal ultrasound. Methods: This was a retrospective cohort study of asymptomatic high-risk singleton pregnancies with a short cervix and history of sPTB, treated using Arabin pessary or vaginal progesterone for primary PTB prevention, conducted at four European hospitals. A log-rank test on Kaplan-Meier curves was used to assess the difference in performance of pessary and progesterone, according to history of PTL-IM or PPROM. Linear regression analysis was used to evaluate significant predictors of gestational age at delivery. Results: Between 2008 and 2015, 170 women were treated with a pessary and 88 with vaginal progesterone. In women treated with a pessary, rate of sPTB < 34 weeks was 16% in those with a history of PTL-IM and 55% in those with a history of PPROM. In women treated with progesterone, rate of sPTB < 34 weeks was 13% in those with a history of PTL-IM and 21% in those with a history of PPROM. Treatment with a pessary resulted in earlier delivery in women with previous PPROM than in any other subgroup (P < 0. 0001). Linear regression analysis showed a clear effect of PPROM history (P < 0. 0001), combination of PPROM history and treatment (P = 0. 0003) and cervical length (P = 0. 0004) on gestational age at birth. Conclusions: Cervical pessary may be a less efficacious treatment option for women with previous PPROM; however, these results require prospective validation before change in practice is recommended. Phenotype of previous preterm birth may be an important risk predictor and treatment effect modifier; this information should be reported in future clinical trials. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Arabin pessary ; PPROM ; Preterm birth ; Short cervix ; Vaginal progesterone
Publicado en:	Ultrasound in obstetrics & gynecology, Vol. 53 Núm. 4 (april 2019) , p. 529-534, ISSN 1469-0705

DOI: 10.1002/uog.19118
PMID: 29920812

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