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OB/GYN
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Preterm Birth Prevention
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Prior preterm vs cervical length.
Decision
Outcome
Decision
Pregnant patient — prior preterm delivery?
✓
No → 2nd-trimester TVUS for cervical length
✓
Yes → assess prior PTB context
Decision
Cervical length?
✓
Normal → routine care
✓
Short (≤2.5 cm at <24 wk) → vaginal progesterone
Outcome
Routine prenatal care
Outcome
Vaginal progesterone
Decision
Prior PTB with painful contractions?
✓
No (cervical insufficiency) → prophylactic cerclage at 12–14 wk
✓
Yes (prior preterm labor) → IM 17-hydroxyprogesterone caproate weekly from 16–36 wk
Outcome
Prophylactic cerclage
Outcome
Weekly IM 17-OHPC
17-OHPC effectiveness recently disputed; SMFM continues to support per shared decision-making.
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