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Poster Session 1

Category: Clinical Obstetrics

Poster Session 1

(191) Comparative latency following mid-trimester cerclage in combination with vaginal progesterone.

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Ethan Litman, MD, MS (he/him/his)

Clinical Fellow
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States

Coauthor(s)

Ai-ris Y. Collier, MD (she/her/hers)

Assistant Professor
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States

Objective:
There are no consensus guidelines for the use of combined therapy (cerclage and vaginal progesterone) for ultrasound-indicated or physical exam-indicated cerclage performed in mid-gestation of pregnancy. Our objective is to define pregnancy latency following cerclage in combination with vaginal progesterone use before and/or after cerclage placement in comparison to cerclage alone.

Study Design:
We utilized the Epic cosmos database to identify a cohort of pregnant individuals with cerclage procedure at 18-24 weeks gestational age from Jan 2015- Dec 2024 with singleton pregnancies who gave birth after 24 weeks. Patients with multifetal gestations, prescription for intramuscular progesterone, or missing birth records were excluded. Progesterone exposure was defined by presence of micronized progesterone prescription prior to and/or after cerclage procedure to generate 4 exposure groups: 1) No progesterone before nor after cerclage; 2) Progesterone before cerclage only; 3) Progesterone after cerclage only; and 4) Progesterone before and after cerclage. Data are presented as percent survival (undelivered) by group using Kaplan-Meier curve. P</span>airwise comparisons of survival estimates at 28, 32, 34, and 37 weeks were reported with 95% confidence intervals (CI).

Results:
19,509 pregnancies were identified with cerclage placement at 18-24 weeks, including 10,666 in group 1; 4544 group 2; 2853 in group 3; and 1446 in group 4. 50% of pregnancies survived to at least 36 weeks gestation for all groups (Fig. 1). Progesterone initiation after cerclage was associated with the lowest survival at all timepoints; whereas progesterone both pre- and post-cerclage was associated with highest survival (Table 1). Progesterone added after cerclage conferred no additional survival benefit.

Conclusion:
Data from this large cohort suggests that continuing progesterone after cerclage has highest benefit for pregnancy latency, but initiating progesterone after cerclage is associated with worse latency.