Comparative effectiveness of cervical cerclage versus vaginal progesterone in the prevention of preterm birth among women with short cervix: A prospective study

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Background: Preterm birth is a leading cause of neonatal morbidity and mortality. A short cervix identified on transvaginal ultrasonography is a significant predictor of preterm delivery. Both cervical cerclage and vaginal progesterone are used as preventive interventions, but their comparative effectiveness remains a subject of clinical interest. Aim: To compare the effectiveness of cervical cerclage and vaginal progesterone in preventing preterm birth among women with a short cervix. Methods: This prospective comparative study was conducted at a tertiary care center in Tamil Nadu and included 150 pregnant women with singleton gestation and cervical length ?25 mm between 16-24 weeks. Participants were allocated into two groups: cervical cerclage (n=75) and vaginal progesterone (n=75). They were followed until delivery. Primary outcome was incidence of preterm birth (<37 weeks). Secondary outcomes included gestational age at delivery, birth weight, NICU admission, and maternal complications. Results: The incidence of preterm birth was significantly lower in the cerclage group compared to the progesterone group (20.0% vs 34.7%, p=0.04). Mean gestational age at delivery was higher in the cerclage group (37.4 ± 1.8 weeks vs 36.5 ± 2.3 weeks, p=0.02). Mean birth weight was also significantly higher in the cerclage group (2.82 ± 0.42 kg vs 2.54 ± 0.48 kg, p=0.001). Maternal complications and NICU admissions were comparable between groups. Conclusion: Cervical cerclage is more effective than vaginal progesterone in reducing preterm birth in women with short cervix, with comparable safety profiles.

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