I recently had a cerclage [cervical stitch] put in place at 20 weeks. They also prescribed progesterone for the remainder of my pregnancy. I don’t want to continue with the progesterone, in fear that it will cause harm to my baby. Do you have any recommendations on how I can have this conversation with my doctors? Any helpful statistics saying that I should or should not continue with taking progesterone even though my cerclage has closed my cervix? Thanks!—Crocheted crotch
Your question brings up two different, but related, questions: Is there any benefit to progesterone in the setting of a cerclage, and is there risk to progesterone?
In terms of benefit, the short answer is we don’t know. There are good data that vaginal progesterone is beneficial in the setting of a short cervix, and there are good data that in certain patients with a short cervix, cerclage is beneficial. However, there are not many well-designed studies examining if there is incremental benefit to vaginal progesterone in someone with a cerclage in place. A recent meta-analysis suggests there is benefit, but the included studies were not all high-quality.
As for risk, many large well-designed studies have shown no risk to the baby from taking supplemental progesterone. Any theoretical risk of birth defects would not be relevant for progesterone started after 16 weeks, which is typical when it is used for the prevention of preterm birth.
So in summary: There may be benefit to adding progesterone, but it is not yet proven. There is no known risk.
When approaching this with your doctor, it should be rather straightforward. Ask her or him what they think the benefits and possible risks are, and then make a decision for yourself how you want to proceed. If you decline their recommendation for progesterone, they may push back a little, but it shouldn’t be a big issue.