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Susten 24-25 Survey
    A. Prevention of spontaneous preterm delivery

    Spontaneous preterm birth (delivery before 37 completed weeks) is the single most important cause of perinatal morbidity and mortality. The rate is increasing world-wide with a great disparity between low, middle and high income countries. It has been estimated that the cost of neonatal care for preterm babies is more than 4 times that of a term neonate admitted into the neonatal care. Furthermore, there are high costs associated with long-term morbidity in those who survive the neonatal period. Interventions to stop delivery once preterm labor starts are largely ineffective hence the best approach to reducing the rate and consequences is prevention. This is either primary (reducing or minimizing factors associated with preterm birth prior to and during pregnancy) or secondary - identification and amelioration (if possible) of factors in pregnancy that are associated with preterm labor. The role of genetics, infections and probiotics and how these emerging dimensions help in the diagnosis of preterm birth and consequently prevention are exciting and hopefully may identify sub-populations for targeted strategies.

    Please read the full text of the article here - https://www.tandfonline.com/doi/full/10.1080/14767058.2023.2183756

  1. Do you agree that for asymptomatic women (i.e., those with no previous history of preterm birth), vaginal progesterone should be the primary treatment when cervical length is >10mm and ≤25mm at <28 weeks’ gestation? *

  2. Do you agree that vaginal progesterone is the intervention with more consistent effectiveness for preventing preterm birth in singleton at-risk pregnancies overall and in those with a previous preterm birth, as compared to intramuscular 17-OHPC, cerclage, and pessary? *

  3. Do you agree that prophylactic vaginal progesterone or prophylactic cervical cerclage should be offered to women who have history of SPTB (≤34 weeks) or mid-trimester loss (from 16 weeks onwards) and cervical length of ≤25mm on TVS at 16-24 weeks? *

  4. SMFM recommends that “routine cervical length screening in multiple pregnancies is not indicated,” while the ISUOG states that “for twin pregnancies, cervical length measurement is the preferred method of screening for preterm birth”. Which statement do you agree with? *

  5. Do you agree that administration of vaginal progesterone to asymptomatic women with a twin gestation and a sonographic short cervix in the mid-trimester reduces the risk of preterm birth occurring at <30 to <35 gestational weeks, neonatal mortality and some measures of neonatal morbidity? *

  6. Do you agree that for those with twins and a previous history of SPTB, vaginal progesterone should be offered from 16 weeks of gestation and should be continued until at least 32 weeks of gestation? *

    7. B. Luteal Phase Support During Assisted Reproductive Technology

    Following continued development, assisted reproductive technology (ART) procedures now have enormous potential as a tool for treating infertility. Success rates in ART are dependent on both medical management and patient characteristics. Personalized management strategies have been proposed to optimize efficacy and safety outcomes. Furthermore, a personalized approach, encompassing shared decision-making between patients and clinicians, could help to alleviate the psychological burden associated with treatment. Such strategies may have the added benefit of reducing discontinuation rates.

    Please read the full text of the article here - https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2021.675670/full

  7. Do you agree that there is a strong association between the number of oocytes and the live birth rate following fresh IVF cycles and a positive linear association with cumulative live birth rates (in fresh and frozen)? *

  8. Do you agree that Vaginal Progesterone Therapy Represents the Gold Standard Approach for Luteal Phase Support After IVF/ICSI? *

  9. Do you agree that addition of GnRH Agonist Injections to Progesterone in Luteal Phase Support Appears to Improve Pregnancy Outcome? *

  10. Do you agree that addition of LH Activity to Progesterone in Luteal Phase Support Improves Pregnancy Outcomes in GnRH Agonist Trigger Fresh Embryo Transfer Cycles? *