Combination of cervical cerclage and vaginal progesterone for prevention of preterm birth in singleton pregnancy with a short cervix: a scoping review

Background Women with a short cervix are at increased risk of preterm birth (PTB), a major contributor to neonatal morbidity and mortality globally, leading to significant financial and emotional burdens for families and healthcare systems. Cerclage or vaginal progesterone is effective for reducing PTB, but the benefits of combining both interventions remain unclear and nonconclusive. Aim This scoping review aimed to critically appraise current evidence on the effectiveness of combining cerclage and vaginal progesterone in managing short cervix in singleton pregnancies to prevent PTB. Design PubMed and Embase were searched for studies published between 2018–2024. The authors independently performed screening and data extraction. Studies that included singleton pregnancies with short cervix (defined as cervical length <25 mm) and comparing combination therapy (cerclage and vaginal progesterone) versus either intervention alone were included. This review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews (PRISMA‐ScR) guidelines and applied the Arksey and O'Malley framework. Results A total of 923 studies were identified and 12 studies were included. Most studies had a retrospective design ( n = 10). Combination of cerclage and vaginal progesterone showed a trend towards improved maternal and neonatal outcomes, including prolonging pregnancy period particularly in high‐risk populations with cervical length ≤10 mm; however, five studies did not demonstrate statistically significant benefits. Conclusion This review highlighted the need for larger, well‐designed studies to evaluate the efficacy and cost‐benefit analysis of cerclage and vaginal progesterone in the prevention of PTB in singleton pregnancies with short cervix as compared to either intervention alone.