Progesterone and Preterm Birth

Jane E Norman*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

10 Downloads (Pure)

Abstract

Progestogens (vaginal progesterone and intramuscular 17-hydroxyprogesterone acetate) are widely recommended for women at high risk of preterm birth. Typical regimens include 17-hydroxyprogesterone caproate (250 mg intramuscularly weekly), starting at 16–20 gestational weeks until 36 weeks or delivery for women with a singleton gestation and a history of spontaneous preterm birth, or vaginal progesterone (90-mg vaginal gel or 200-mg micronized vaginal soft capsules) for women with a short cervix (typically ≤25 mm). Although some randomized trials support this approach, neither of the largest trials (PROLONG for 17-hydroxyprogesterone acetate or OPPTIMUM for vaginal progesterone) demonstrated efficacy. There are almost no data on long-term effects, and none that shows benefit beyond the neonatal period. Although some analyses suggest the cost-effectiveness of the approach, a cervical length screening program followed by progesterone for those with a short cervix will reduce preterm birth rates by less than 0.5%. The present review assesses evidence on the efficacy, likely impact, and long-term effects of implementing the recommendations for progestogens in full. Clinicians and pregnant women can look forward to resolution of the conflicting views on efficacy once the Patient-Centered Outcomes Research Initiative (PCORI)-funded individual patient data meta-analysis is published.
Original languageEnglish
Pages (from-to) 24-30
Number of pages7
JournalInternational Journal of Gynecology and Obstetrics
Volume150
Issue number1
Early online date10 Jun 2020
DOIs
Publication statusPublished - 1 Jul 2020

Keywords

  • 17‐Hydroxyprogesterone acetate
  • Preterm birth
  • Preterm labor
  • Prevention
  • Progesterone

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