الفهرس 
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Abstract
Prematurity is the leading cause of neonatal morbidity and mortality. Although perinatal care advanced in the last few decades, preterm labor did not decrease but even is increasing and creating a great social and economic problem.
In Europe and many developed countries the preterm birth rate is generally 6-10%, and in the USA it reaches 11-14 % in the last few years.
About 40-45% of preterm labor incidence occurs spontaneously ,25-30% occurs due to premature rupture of membrane and the remained 30-35% are induced due to medical reasons as intrauterine environment (i.e. infection, intrauterine growth retardation) or significant endangerment of the maternal health (i.e. preeclampsia, cancer).
First step of prevention is about to identify women at risk. Recent studies have identified clinical, sonographic, and biochemical markers that help to identify the women at highest risk. Measuring cervical length and cervico-vaginal fibronectin have been proposed as useful tools for evaluating women at risk of preterm birth and may identify those who might benefit from antenatal corticosteroids, but effective interventions to prevent preterm birth remain elusive.
Treatment of established preterm labor should be directed towards identifying those women who will get a benefit of delaying labor and those in whom it may be lethal in terms of neonatal or infant outcome. Although there is little hard evidence that tocolysis improves the outcome for the baby, most obstetricians treat threatened uncomplicated preterm labor in order to administer steroids to improve lung maturity of the foetus or transfer the mother to an appropriate hospital.
Studies showed that progesterone has a role in the establishment and maintenance of pregnancy, so ,it has been a natural choice for the treatment and prevention of preterm labor.Alot of trials examined the use of progesterone in preterm labor as maintenance tocolytic,it has a positive role in increasing the duration of pregnancy,mean foetal weight,reducing rates of preterm births,neonatal complications of prematurity and decreasing neonatal mortality rates.So many recent studies and trials encourage the use of prophylactic progesterone in high risk patients of preterm labor as Meis et al 2003 ,also my study supports the use of progesterone in prevention of preterm labor.
Cervical cerclage has been used in prevention of preterm labor as a therapeutic method in cases of short cervix less than 2.5cm,however results of its use are doubtful, but prophylactic use of cerclage in cases of normal cervical length ,has been more related to patients with history of recurrent second trimesteric abortion and previous preterm labor of unknown causes which suggests cervical insufficiency.Prophylactic cerclage shows encouraging results in prevention of preterm labor in patients with previous history of preterm labor.
Our study is a multicenter randomized controlled prospective study that was conducted at El-fashn central hospital and Beni-suef general hospital from june 2015 till february 2017..In our study comparison between vaginal progesterone 400 mg daily starting at 16 weeks gestational age ,prophylactic McDonald cervical cerclage @13-14 weeks and oral progesterone(duphaston 20 mg daily)@ 16 weeks, revealed that all of theses methods reduce the recurrence of preterm labour, with vaginal progesterone more superior as this method was associated with better gestational age at time of delivery, less need to tocolysis and patients, compliance is good. On the other hand more complications were associated with cerclage regarding need to tocolysis, pyrexia and vaginal discharge .The mean gestational age of current deliveries between the 3 study groups,it was 37.9 ±2.1 in group A ,versus 36.7± 2.9 in group B,versus 37.9±2.3 in group C.otherwise no Statistical difference between the three methods regarding age,BMI,gravity and parity and neonatal morbidity and .