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Management of women with previous preterm delivery or second-trimester loss

Management of women with previous preterm delivery or second-trimester loss
Patient population Interventions to be considered Options in next pregnancy if history-indicated cerclage was not successful (ie, preterm birth <33 weeks)
Women with:
  • ≥2 consecutive prior second-trimester losses* or
  • ≥3 early (<34 weeks) preterm births

Transvaginal cerclage at 12 to 14 weeks and

Hydroxyprogesterone caproate 250 mg IM weekly from 16 to 36 weeks

Transabdominal cerclage

Hydroxyprogesterone caproate 250 mg IM weekly from 16 to 36 weeks
Women with:
  • One prior second-trimester loss* or
  • One or two preterm births 

Hydroxyprogesterone caproate 250 mg IM weekly from 16 to 36 weeks

Serial measurement of cervical length beginning at 14 to 16 weeks and ending at 24 weeks

If cervical length ≤25 mm before 24 weeks, place transvaginal cerclage

  
IM: intramuscular.
* Usually a spontaneous pregnancy loss between 16 and 27+6 weeks of gestation.
Data from: Iams JD, Berghella V. Care for women with prior preterm birth. Am J Obstet Gynecol 2010; 203:89.
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