The use of progesterone to prevent preterm delivery

There have been a number of recent publications which suggest that administration of progesterone may1, 2 or may not3 reduce the risk of preterm delivery in women at high risk of preterm labour.  Consequently there is considerable debate as to whether progesterone should be administered in clinical practice to such women.  What constitutes “high risk” is uncertain, but may include previous preterm delivery and/or a short cervix4, 5
Although a reduction in preterm birth seems attractive, there is little evidence as yet for short term benefit to the baby, even if progesterone does prevent preterm delivery. Furthermore, there is no evidence of long term benefit for the baby. This may not just be “absence of evidence” as it is becoming increasingly recognised that a delay in delivery could have adverse effects if the fetus remains in an adverse intrauterine environment.  The RCOG therefore endorses current recommendations that, in women at high risk of preterm delivery, progesterone administration should be restricted to clinical trials to determine whether its use is associated with improved fetal, neonatal and/or infant outcome.

References

  1. Meis PJ, Klebanoff M, Thom E, et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med. 2003 Jun 12; 348(24):2379-85.
  2. Fonseca EB, Bittar RE, Carvalho MH, et al. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study. Am J Obstet Gynecol. 2003 Feb; 188(2):419-24.
  3. O’Brien JM, Adair CD, Lewis DF, Hall DR, Defranco EA, Fusey S, et al. Progesterone vaginal gel for the reduction of recurrent preterm birth: primary results from a randomized double blind placebo controlled trial. Ultrasound Obstet Gynecol 2007;30: 687–96.
  4. Fonseca EB, Celik E, Parra M, Singh M, Nicolaides KH; Progesterone and the risk of preterm birth among women with a short cervix. N Engl J Med. 2007 Aug 2; 357(5):462-9.
  5. Use of progesterone to reduce preterm birth. ACOG Committee Opinion No. 419. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 419. Obstet Gynecol 2008; 112: 963-5.

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