Full length article| Volume 259, P119-124, April 2021

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Evaluation of the efficacy of vaginal progesterone in preventing preterm birth after abdominal trachelectomy

Published:February 13, 2021DOI:


      • Pregnant women after abdominal trachelectomy (AT) were high risk at preterm birth.
      • Vaginal progesterone (VP) did not prevent preterm birth in women after AT.
      • Presence of uterine cervix is essential for preventive effects of VP on preterm birth.



      To determine whether vaginal progesterone (VP) reduces the rate of preterm birth in pregnant women after abdominal trachelectomy (AT) for early-stage cervical cancer

      Study Design

      This is an interventional study with a historical cohort. For the interventional study participants who had singleton pregnancies after AT between October 2016 and September 2020, the administration of vaginal progesterone was started between 16+ and 19+6 weeks of gestation and discontinued at 34 weeks of gestation or at the time of delivery, rupture of membranes, or massive uterine bleeding. We investigated obstetric and neonatal outcomes among the study participants and compared them with outcomes of the historical control group participants, included women with singleton pregnancies after AT who were managed without VP at our institution between January 2007 and September 2016, using Fisher’s exact test and the Mann–Whitney U test The main outcomes were the gestational age at delivery and incidence of preterm birth before 37 weeks and 34 weeks of gestation.


      Twelve pregnancies in ten women were included in the VP group. In contrast, 19 pregnancies in 17 women were included in the historical control group. The incidence of preterm birth at <37 weeks was 10/12 (83 %) in the VP group and 11/19 (58 %) in the control group. The incidence of preterm birth at <34 weeks was 6/12 (50 %) in the VP group and 9/19 (48 %) in the control group. The incidence of preterm birth in the two groups was similar, and the difference between the two groups was not statistically significant.


      The administration of vaginal progesterone did not reduce the rate of preterm birth among pregnant women after AT.


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        • Smith J.R.
        • Boyle D.C.
        • Corless D.J.
        • et al.
        Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma.
        Br J Obstet Gynaecol. 1997; 104: 1196-1200
        • Yagi A.
        • Ueda Y.
        • Kakuda M.
        • et al.
        Epidemiologic and clinical analysis of cervical cancer using data from the population-based Osaka Cancer registry.
        Cancer Res. 2019; 79: 1252-1259
        • Willows K.
        • Lennox G.
        • Covens A.
        Fertility-sparing management in cervical cancer: balancing oncologic outcomes with reproductive success.
        Gynecol Oncol Res Pract. 2016; 3: 9
        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer Statistics, 2017.
        CA Cancer J Clin. 2017; : 7-30
        • Wethington S.L.
        • Cibula D.
        • Duska L.R.
        • et al.
        An international series on abdominal radical trachelectomy: 101 patients and 28 pregnancies.
        Int J Gynecol Cancer. 2012; 22: 1251-1257
        • Pareja R.
        • Rendón G.J.
        • Sanz-Lomana C.M.
        • Monzón O.
        • Ramirez P.T.
        Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy - a systematic literature review.
        Gynecol Oncol. 2013; 131: 77-82
        • Kasuga Y.
        • Nishio H.
        • Miyakoshi K.
        • et al.
        Pregnancy outcomes after abdominal radical trachelectomy for early-stage cervical cancer: a 13-year experience in a single tertiary-care center.
        Int J Gynecol Cancer. 2016; 26: 163-168
        • Shah J.S.
        • Jooya N.D.
        • Woodard T.L.
        • Ramirez P.T.
        • Fleming N.D.
        • Frumovitz M.
        Reproductive counseling and pregnancy outcomes after radical trachelectomy for early stage cervical cancer.
        J Gynecol Oncol. 2019; 30: e45
        • Li X.
        • Xia L.
        • Li J.
        • Chen X.
        • Ju X.
        • Wu X.
        Reproductive and obstetric outcomes after abdominal radical trachelectomy (ART) for patients with early-stage cervical cancers in Fudan.
        China. Gynecol Oncol. 2020; 157: 418-422
        • Tamauchi S.
        • Kajiyama H.
        • Sakata J.
        • et al.
        Oncologic and obstetric outcomes of early stage cervical cancer with abdominal radical trachelectomy: single-institution experience.
        J Obstet Gynaecol Res. 2016; 42: 1796-1801
        • Meis P.J.
        • Klebanoff M.
        • Thom E.
        • et al.
        Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate.
        N Engl J Med. 2003; 348: 2379-2385
        • Dodd J.M.
        • Jones L.
        • Flenady V.
        • Cincotta R.
        • Crowther C.A.
        Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth.
        Cochrane Database Syst Rev. 2013; CD004947
        • Romero R.
        • Conde-Agudelo A.
        • Da Fonseca E.
        • et al.
        Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data.
        Am J Obstet Gynecol. 2018; 218: 161-180
        • O’Brien J.M.
        • Lewis D.F.
        Prevention of preterm birth with vaginal progesterone or 17-alpha-hydroxyprogesterone caproate: a critical examination of efficacy and safety.
        Am J Obstet Gynecol. 2016; 214: 45-56
        • Iams J.D.
        • Berghella V.
        Care for women with prior preterm birth.
        Am J Obstet Gynecol. 2010; 203: 89-100
        • Norman J.E.
        Progesterone and preterm birth.
        Int J Gynecol Obstet. 2020; 150: 24-30
        • Society for Maternal-Fetal Medicine Publications Committee, with assistance of Vincenzo Berghella
        Progesterone and preterm birth prevention: translating clinical trials data into clinical practice.
        Am J Obstet Gynecol. 2012; 206: 376-386
        • Okugawa K.
        • Kobayashi H.
        • Sonoda K.
        • et al.
        Oncologic and obstetric outcomes and complications during pregnancy after fertility-sparing abdominal trachelectomy for cervical cancer: a retrospective review.
        Int J Clin Oncol. 2017; 22: 340-346
        • Hassan S.S.
        • Romero R.
        • Vidyadhari D.
        • et al.
        Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial.
        Ultrasound Obstet Gynecol. 2011; 38: 18-31
        • Society for Maternal Fetal Medicine Publications Committee
        ACOG Committee Opinion number 419 October 2008 (replaces no. 291, November 2003). Use of progesterone to reduce preterm birth.
        Obstet Gynecol. 2008; : 963-965
        • Winer N.
        • Bretelle F.
        • Senat M.V.
        • et al.
        17 alpha-hydroxyprogesterone caproate does not prolong pregnancy or reduce the rate of preterm birth in women at high risk for preterm delivery and a short cervix: a randomized controlled trial.
        Am J Obstet Gynecol. 2015; 212485.e1-10
        • Maher M.A.
        • Abdelaziz A.
        • Ellaithy M.
        • Bazeed M.F.
        Prevention of preterm birth: a randomized trial of vaginal compared with intramuscular progesterone.
        Acta Obstet Gynecol Scand. 2013; 92: 215-222
        • Jain V.
        • McDonald S.D.
        • Mundle W.R.
        • Farine D.
        Guideline No. 398: progesterone for prevention of spontaneous preterm birth.
        J Obstet Gynaecol Can. 2020; 42: 806-812