Evidence-based recommendations from 5 international guidelines and meta-analyses
Romero et al. | ACOG | SMFM | NICE | SOGC
Clinical Decision Support Tool. This tool synthesizes evidence from Roberto Romero and Agustin Conde-Agudelo's meta-analyses, ACOG Practice Bulletin 234 (2021/2023 Advisory), SMFM Consult Series #70 (2024), NICE NG25 (2022), and SOGC Guideline 398 (2020). It is not a substitute for clinical judgment. All recommendations should be discussed with the patient's healthcare provider.
1
Gestational Age
Pregnancy Dating
Enter gestational age directly or calculate from due date
Current Gestational Age
2
Cervical Assessment
Cervical Length Measurement
Transvaginal ultrasound measurement (the gold standard per Romero et al.)
Measured by transvaginal ultrasound between 16-24 weeks
3
Pregnancy Details
Number of Fetuses and History
These factors determine which evidence pathways apply
4
Additional Factors
Other Risk Factors
Select all that apply
Key References
[Romero] 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(2):161-180.
[Romero] Conde-Agudelo A, Romero R, Da Fonseca E, et al. Vaginal progesterone is as effective as cervical cerclage to prevent preterm birth in women with a singleton gestation, previous spontaneous preterm birth, and a short cervix: updated indirect comparison meta-analysis. Am J Obstet Gynecol. 2018;219(1):10-25.
[Romero] Romero R, Yeo L, Miranda J, et al. A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix. J Perinat Med. 2013;41(1):27-44.
[Romero] Conde-Agudelo A, Romero R, Rehal A, et al. Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in twin gestations: a systematic review and meta-analysis. Am J Obstet Gynecol. 2023;229(6):599-616.e3.
[Romero] Romero R, Meyyazhagan A, Hassan SS, Creasy GW, Conde-Agudelo A. Vaginal Progesterone to Prevent Spontaneous Preterm Birth in Women With a Sonographic Short Cervix: The Story of the PREGNANT Trial. Clin Obstet Gynecol. 2024;67(2):433-457.
[Romero] Romero R, Conde-Agudelo A, Nicolaides KH. There is insufficient evidence to claim that cerclage is the treatment of choice for patients with a cervical length <10 mm. Am J Obstet Gynecol. 2018;219(2):213-215.
[Romero] Conde-Agudelo A, Romero R, Nicolaides KH. Cervical pessary to prevent preterm birth in asymptomatic high-risk women: a systematic review and meta-analysis. Am J Obstet Gynecol. 2020;223(1):42-65.e2.
[ACOG] Prediction and prevention of spontaneous preterm birth. ACOG Practice Bulletin No. 234. Obstet Gynecol. 2021;138:e65-90.
[ACOG] Updated Clinical Guidance for the Use of Progesterone Supplementation for the Prevention of Recurrent Preterm Birth. ACOG Practice Advisory. 2023.
[SMFM] Society for Maternal-Fetal Medicine (SMFM), Biggio J, SMFM Publications Committee. SMFM Consult Series #70: Management of short cervix in individuals without a history of spontaneous preterm birth. Am J Obstet Gynecol. 2024;231(2):B2-B13.
[NICE] National Institute for Health and Care Excellence. Preterm labour and birth. NICE guideline NG25. Updated 2022.
[SOGC] Jain V, McDonald SD, Mundle WR, Farine D. Guideline No. 398: Progesterone for Prevention of Spontaneous Preterm Birth. J Obstet Gynaecol Can. 2020;42(6):806-812.
Conde-Agudelo A, Romero R. Vaginal progesterone does not prevent recurrent preterm birth in women with a singleton gestation, a history of spontaneous preterm birth, and a midtrimester cervical length >25 mm. Am J Obstet Gynecol. 2022;227:923-926.
Putora K, Hornung R, Kinkel J, Fischer T, Putora PM. Progesterone, cervical cerclage or cervical pessary to prevent preterm birth: a decision-making analysis of international guidelines. BMC Pregnancy Childbirth. 2022;22(1):413.