Prevention of preterm labor

Premature birth is a serious global problem with a high rate of neonatal morbidity and mortality.

Transvaginal sonography (TVS) of the cervical length is applied to diagnose the risk of preterm birth. Thereby, premature cervical ripening or even premature opening of the cervix with funneling can be assessed. Underlying risk factors (e.g. infertility treatment) can fortify the background risk of premature birth.  The prevention strategies are partly based due to scientific criteria of previous studies.

Surgical closure of the cervix (cerclage)

For mothers with multiple pregnancies, most studies could not prove any evident benefit of a surgical cervical cerclage . Even worse,  this surgery may also carry risks, such as premature rupture of the bladder and, in some studies, even increasing the rate of premature birth in multiple pregnancies. The operator performing this procedure must have a sufficient experience. The cerclage should be removed at 36 weeks of gestation.

Application of vaginal progesterone

After careful review of the studies, vaginal progesterone has no place in the prevention of premature birth, possible side effects are a triggering of gestational diabetes and  long-term effects that have not been sufficiently evaluated.

Pessary specific for prophylaxis of premature birth

There seems to be a benefit of a cervical pessary to prevent premature birth. The insertion is painless, allows the mother to be treated immediately, to stay at home, and to eliminate the risks of surgery and medication. The only side effect is an increased discharge as an expression of mechanical pressure. Pessaries should be placed as early as necessary, in case of cervical shortening, e.g. < 38 mm before the 20th week of pregnancy. The health care provider should have experience in the care of the impending premature birth and pessary treatment and also carry out the further follow up checks. Prior to birth, the pessary should be removed.

If your health care provider has not sufficient experience in pessary insertion, surveillance and removal, the pessary guidelines of the German task force of Obstetrics und Prenatal Medicine and the instructions for pessary management can be viewed here: https://www.youtube.com/watch?v=5x2g6Eg2f0o

More information that is detailed can be found in our information leaflet.