Progesterone Treatment and Cervical Length Screening
Prematurity remains the leading cause of neonatal morbidity and mortality. Two major risk factors for preterm birth are a history of previous spontaneous preterm birth and a short cervix on ultrasound screening.
In low-risk patients with an incidental finding of a short cervix noted at the time of anatomy ultrasound (16 to 20 weeks gestation), daily treatment with vaginal progesterone has been shown to reduce the risk of spontaneous preterm birth.
In patients with a previous history of spontaneous preterm birth, treatment with weekly intramuscular 17alpha hydroxyprogesterone (17P) has been shown to significantly reduce the risk of recurrence. In those with a singleton gestation who have a history of a spontaneous preterm birth and a current shortened cervix on ultrasound, placement of a cerclage reduces the risk of preterm birth.
The following outlines a management plan for the utilization of second trimester ultrasound to screen for a short cervix and progesterone therapy to reduce the incidence of preterm birth.
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