Prophylactic Cervical Cerclage versus Vaginal Progesterone in Triplet Pregnancy—A Randomized Prospective Comparative Study

Abstract

Objective: To compare the effect of prophylactic cervical cerclage with vaginal progesterone in triplet (with normal cervical measurements) to evaluate its efficacy in improving pregnancy outcome and prolonging gestation. Design: A randomized prospective comparative study. Setting: At Tanta university hospitals and outpatient clinics. Patients: 51 selected cases of triplet pregnancy were recruited and classified into 2 groups randomly, progesterone group (n = 28 cases) and cerclage group (n = 23 cases). Interventions: Transvaginal ultrasound was done for number of fetuses, viability, cervical measurements, vaginal progesterone for progesterone starting at 20 weeks, and applying McDonald cerclage at 14 -16 weeks for cerclage group. Main Outcome Measures: Time of occurrence of preterm labor, premature rupture of membranes (PROM), stitch removal, gestational age at delivery, mode of delivery, and neonatal complications. Results: Preterm labor occurred in 9, 8 cases and PROM in 4, and 3 cases in progesterone and cerclage groups respectively. The mean gestational age was 33.57 ± 2.97 and 31.74 ± 3.21 weeks in progesterone and cerclage groups; mean birth weight was 2049 ± 591 gm, and 1686 ± 512 gm in progesterone and cerclage groups respectively; Apgar score 7 or more was found in 52 (60.8%), and 39 (56.3%) newborn in progesterone and cerclage group respectively. Perinatal mortality was lower in progesterone group 26.1% (3 IUFD+19 neonatal) than in cerclage group 30.4% (2 IUFD + 19 neonatal). Respiratory distress syndrome (RDS) occurred in 43.9%, 49.76%, while need of mechanical ventilation occurred in 12.2%, 16.41% of progesterone and cerclage groups respectively and neonatal jaundice was found in 49.38%, 53.7% of progesterone and cerclage groups respectively. Conclusion: Vaginal progesterone seems to be more effective than prophylactic cerclage in reducing preterm delivery in triplet pregnancies with normal cervical measurements even in those with prior history of preterm labour and minimizing neonatal morbidity and mortality.