Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta‐analysis

摘要: Background Preterm birth (PTB) is the leading cause of infant death, but it unclear which intervention best to prevent it. Objectives To compare progesterone, cerclage and pessary, determine their relative effects rank them. Search strategy We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL Web Science (to April 2016), without restrictions, screened references previous reviews. Selection criteria We included randomised trials or pessary for preventing PTB in women with singleton pregnancies at risk as defined by each study. Data collection analysis We extracted data duplicate using a piloted form performed Bayesian random-effects network meta-analyses pairwise meta-analyses. We rated evidence quality GRADE, ranked interventions SUCRA calculated numbers needed treat (NNT). Main results We 36 (9425 women; 25 low bias trials). Progesterone first second most outcomes, reducing < 34 weeks [odds ratio (OR) 0.44; 95% credible interval (CrI) 0.22–0.79; NNT 9; quality], <37 (OR 0.58; CrI 0.41–0.79; moderate quality), neonatal death 0.50; 0.28–0.85; 35; high compared control, overall risk. found similar results subgroup PTB, only reduction short cervix. Pessary showed inconsistent benefit did not reduce 37 <34 weeks. Conclusions Progesterone was risk, weeks, demise other sequelae. Tweetable abstract Progesterone better than preterm birth, more meta-analysis.