الفهرس 
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Abstract
Preterm birth is one of the most important issues in reproductive medicine; in 2002, the preterm delivery rate was 12%. Preterm birth also accounts for the vast majority of perinatal mortality and both short- and long-term neonatal morbidity. The major diseases of the preterm infant result from organ immaturity, and the incidence and severity of disease are inversely related to gestational age. Prophylaxis of SPTB is still uncertain, but there are a number of available interventions that may decrease the incidence.
In asymptomatic women presenting with prior history of PTB, the early prophylaxis with either microionized progesterone 200mg vaginal or cervical pessary or cerclage have shown in many studies a significant benefit.
This study was undertaken to compare between the effectiveness of vaginal progesterone, cervical cerclage and cervical pessaries in preventing preterm delivery in patients at risk for preterm labour. It was a prospective study conducted in the Obstetric Division, El-Shatby Maternity Hospital, University of Alexandria in Egypt. It involved 150 pregnant women between16-23 gestational weeks selected after fulfilling the criteria of inclusion into the study with informed consent to participate in the study after approval of the ethics committe.
Patients at risk for preterm labour having short cervix(less than 25mm) using transvaginal ultrasound randomly received one of the following management lines:1-200mg vaginal progesterone daily till 36 weeks (50 patients) 2-Cervical cerclage (Mcdonald) (50 patients) 3-Cervical pessary (Arabin pessary) (50 patients). At delivery the following data were documented: 1- Gestational age at time of delivery, 2- Neonatal birth weight. 3- Use of assisted ventilation for the neonate. 4- Occurrence of necrotizing enterocolitis. 5- Neonatal death. 6- Admission to neonatal intensive care unit.
The three groups were comparable regarding the demographic data of age, BMI, mean G.A. at previous birth which was 32 weeks, number of previous preterm deliveries ranging from 1-3 preterm births, mode of previous deliveries and cervical length at 16-23 weeks having a mean of 21-22 mm for the 3 groups.
Regarding the side effects of the three interventions, the vaginal progesterone group mainly complained of vulval irritation. In the pessary group, the main complaint was the vaginal discharge and discomfort. In the cerclage group minor post-operative bleeding occurred to few patients.
In the vaginal progesterone group delivery at the current pregnancy occurred at a mean GA of 35 weeks, with the percentage of delivery at ≥37 was 52%. In the cerclage group delivery occurred at the same mean GA (35 weeks) and the same percentage at ≥37. In the pessary group delivery occurred at almost the same mean GA(34 weeks) but the delivery at ≥37 was 28% which is significantly less than the 2 other groups.
There was no significant difference between the three studied groups regarding the neonatal birth weight, NICU admission, neonatal need for ventilation, necrotizing enterocolitis and neonatal death.
In regards of the above results the use of cervical pessary was comparable to the vaginal progesterone and cervical cerclage for prevention of preterm delivery. In spite of having a lower percentage of delivery after 37 weeks, the use of pessary resulted in almost the same mean GA at delivery and the same neonatal outcome.
More randomized controlled trials and multi-center studies with a higher number of recruited patients are needed to compare between the three interventions before giving definitive recommendations.