Use and Impact of Pessary, Cerclage, and Progesterone for the Secondary Prevention of Preterm Birth: Data from the German Neonatal Network

Abstract

Background To evaluate the use and effect of cervical stitch cerclage, pessary, and progesterone on pregnancy outcome in mothers of very low birth weight infants (VLBWI) born<32 weeks of gestation in the German Neonatal Network (GNN).

Methods The GNN is a population-based cohort study enrolling VLBWI since 2009. We included 575 neonates from 424 mothers into our analysis, who were born between 2015 and 2019, after prenatal intervention with cerclage, pessary, progesterone or a combination between 20/0 to 25/0 weeks of gestation to prevent preterm birth. Median intervention-to-birth interval was the primary endpoint.

Results 231 of 424 pregnant women had a cerclage only (54.5%), 76 women a pessary only (17.9%), and 27 were prescribed progesterone only (15.3%). The most common combination treatment (>1 intervention group) was cerclage plus progesterone (n=27), followed by cerclage plus pessary (n=13). The median intervention-to-birth interval for the whole cohort was 24 days (IQR 19.0 days). The earlier the intervention was started, the longer the intervention-to-birth interval lasted: When started at 20 weeks, the interval was 34 days in contrast to 11.5 days, when started at 25 weeks. The >1 group was born at a significantly higher median GA with 27.0 weeks (IQR 2.9 weeks) and a higher median birth weight of 980 g (IQR 394 g) accordingly.

Conclusion We propose that the earliest possible start of intervention leads to the most efficient pregnancy prolongation.

Zusammenfassung

Hintergrund Bewertung von Einsatz und Effektivität von Cerclage, Pessar und Progesteron auf den Schwangerschaftsverlauf bei Müttern von Frühgeborenen mit sehr niedrigem Geburtsgewicht (VLBWI), die im Rahmen des GNN unter der 32. Schwangerschaftswoche geboren wurden.

Methoden Wir haben 575 Neugeborene von 424 Müttern in unsere Analyse einbezogen, die zwischen 2015 und 2019 nach pränataler Intervention mit Cerclage, Pessar, Progesteron oder einer Kombinationstherapie zur Verhinderung einer Frühgeburt zwischen der 20. und 25. Schwangerschaftswoche geboren wurden. Der mittlere Zeitraum zwischen Intervention und Geburt war der primäre Endpunkt.

Ergebnisse 231 von 424 schwangeren Frauen erhielten nur eine Cerclage (54,5%), 76 Frauen nur ein Pessar (17,9%) und 27 Frauen erhielten nur Progesteron (15,3%). Die häufigste Kombinationsbehandlung (>1 Interventionsgruppe) war die Cerclage plus Progesteron (n=27), gefolgt von Cerclage plus Pessar (n=13). Das mittlere Intervall zwischen Intervention und Geburt betrug für die gesamte Kohorte 24 Tage (IQR 19.0 Tage). Je früher mit der Intervention begonnen wurde, desto länger dauerte das Intervall zwischen Intervention und Geburt: Bei Beginn mit 20 Wochen betrug das Intervall 34 Tage, im Gegensatz zu 11.5 Tagen bei Beginn mit 25 Wochen. Die Gruppe >1 wurde mit einem deutlich höheren mittleren GA von 27.0 Wochen (IQR 2.9 Wochen) und entsprechend höherem Geburtsgewicht von 980 g (IQR 394 g) geboren.

Schlussfolgerung Der frühestmögliche Beginn einer Intervention führt zur effizientesten Verlängerung der Schwangerschaft.

Key words

Secondary prevention - Preterm birth - Impact on prologation

Schlüsselwörter

Sekundärprävention - Frühgeburt - Prologation

Publication History

Received: 28 July 2023

Accepted: 07 November 2023

Article published online:
16 January 2024

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