SynthesisActa obstetricia et gynecologica Scandinavica2026
Can universal cervical length screening with vaginal progesterone for a short cervix reduce preterm birth? A systematic review and meta-analyses.
Synthesis in Acta obstetricia et gynecologica Scandinavica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Universal cervical length screening and vaginal progesterone: Distinguishing strategy effectiveness from treatment efficacy.Acta obstetricia et gynecologica Scandinavica · 2026Article
- Screening strategy versus drug efficacy: Revisiting the evidence for vaginal progesterone in short cervix.Acta obstetricia et gynecologica Scandinavica · 2026Article
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe global rate of preterm birth (PTB) is not declining, resulting in approximately one million deaths annually among children under five due to complications related to PTB. Universal cervical length screening followed by progesterone treatment in women with a short cervix has been proposed as a preventive strategy. We systematically assessed the accuracy of this approach in reducing the incidence of PTB and improving neonatal outcomes. MATERIAL AND
methodsWe conducted a systematic literature search and meta-analysis registered in PROSPERO (CRD42024605203). Medline, Embase, and the Cochrane Library were searched in October 2024 and updated in September 2025. Eligible studies included randomized controlled trials (RCTs), cohort studies, and systematic reviews comparing universal cervical length screening with vaginal ultrasound in mid-trimester followed by progesterone treatment versus no screening in asymptomatic women with a singleton pregnancy. Outcomes of interest were any PTB, spontaneous PTB (sPTB), and neonatal outcomes. The certainty of evidence was assessed separately for RCTs and cohort studies using the GRADE approach.
resultsTwo RCTs (1634 participants) and four cohort studies (425 735 participants) were included. Results from RCTs showed no statistically significant reduction in any PTB, sPTB, peri/neonatal mortality, or morbidity after screening versus no screening. In contrast, meta-analyses of cohort studies demonstrated a significant reduction for any PTB < 37 weeks; adjusted odds ratio 0.87, 95% confidence interval (CI) 0.78-0.98, and sPTB < 37 weeks; relative risk 0.82, 95% CI 0.70-0.96. Meta-analyses of cohort studies also demonstrated a significant reduction in sPTB < 34 and <32 weeks. The cohort studies presented no data on neonatal outcomes. The certainty of evidence from RCTs was rated very low due to limited precision and lack of significant results. Although meta-analyses of cohort studies showed significant associations, the certainty of evidence was also very low because of indirectness and a high risk of bias inherent in observational study designs.
conclusionsIt is uncertain, based on very low certainty of evidence, whether universal cervical length screening followed by progesterone treatment for women with a short cervix reduces PTB or affects neonatal outcomes, compared with no screening. More adequately powered trials are needed before a recommendation can be made.
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