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Randomized evidence supports vaginal progesterone for prevention of spontaneous preterm birth in selected women with a short cervix identified on transvaginal ultrasound. The intervention is particularly relevant because cervical shortening can precede clinically apparent preterm labor, creating an opportunity for targeted prevention. For maternal-fetal medicine practice, treatment should be based on gestational age, obstetric history and cervical-length findings rather than prescribed universally to all pregnant women. The evidence also illustrates the value of standardized cervical-length screening pathways when the population is appropriate. Clinicians should counsel patients about adherence, expected benefit and the limits of preventive therapy. Progesterone does not eliminate the need to evaluate symptoms, membrane status or other causes of preterm birth. The study fits AICOG's high-risk obstetric track because it demonstrates how ultrasound-based risk stratification can lead to a relatively simple intervention with potential to reduce prematurity and its neonatal consequences.
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Randomized evidence supports vaginal progesterone for prevention of spontaneous preterm birth in selected women with a short cervix identified on transvaginal ultrasound. The intervention is particularly relevant because cervical shortening can precede clinically apparent preterm labor, creating an opportunity for targeted prevention. For maternal-fetal medicine practice, treatment should be based on gestational age, obstetric history and cervical-length findings rather than prescribed universally to all pregnant women. The evidence also illustrates the value of standardized cervical-length screening pathways when the population is appropriate. Clinicians should counsel patients about adherence, expected benefit and the limits of preventive therapy. Progesterone does not eliminate the need to evaluate symptoms, membrane status or other causes of preterm birth. The study fits AICOG's high-risk obstetric track because it demonstrates how ultrasound-based risk stratification can lead to a relatively simple intervention with potential to reduce prematurity and its neonatal consequences.
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