{Reference Type}: Case Reports
{Title}: Progesterone, cervical cerclage or cervical pessary to prevent preterm birth: a decision-making analysis of international guidelines.
{Author}: Putora K;Hornung R;Kinkel J;Fischer T;Putora PM;
{Journal}: BMC Pregnancy Childbirth
{Volume}: 22
{Issue}: 1
{Year}: Apr 2022 23
{Factor}: 3.105
{DOI}: 10.1186/s12884-022-04584-4
{Abstract}: <B>OBJECTIVE: </B>The aim of this study was to investigate guidelines on preterm birth, analyze decision-criteria, and to identify consensus and discrepancies among these guidelines.<BR><B>METHODS: </B>Objective consensus analysis of guidelines.<BR><B>METHODS: </B>Ten international guidelines on preterm birth.<BR><B>METHODS: </B>Relevant decision criteria were singleton vs. twin pregnancy, history, cervical length, and cervical surgery / trauma or Mullerian anomaly. Eight treatment recommendations were extracted. For each decision-making criteria the most commonly recommended treatment was identified, and the level of consensus was evaluated.<BR><B>METHODS: </B>Consensus and Discrepancies among recommendations.<BR><B>RESULTS: </B>In a case of singleton pregnancies with no history of preterm birth and shortened cervix, most guidelines recommend progesterone. In singleton pregnancies with a positive history and shortened cervix, all guidelines recommend a cerclage as an option, alternative or conjunct to progesterone. The majority of the guidelines advise against treatment in twin pregnancies.<BR><B>CONCLUSIONS: </B>A shortened cervix and a history of preterm birth are relevant in singleton pregnancies. In twins, most guidelines recommend no active treatment. Among international guidelines a shortened cervix and a history of preterm birth are relevant in singleton pregnancies. With no history of preterm birth and with a shortened cervix most guidelines recommend progesterone treatment.