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Prematurity prevention: the role of progesterone
Eduardo B da Fonseca1, Roberto E Bittar, Rievani Damião
1Obstetric Clinic, University of São Paulo Medical School, São Paulo, Brazil. fonseca2003@yahoo.com
Insights
Prophylactic progesterone may reduce preterm birth rates in select pregnant women with a history of early delivery or short cervical length. Further research is needed for other risk factors.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Reproductive Endocrinology
Background:
- Preterm birth affects 7-11% of pregnancies, contributing significantly to neonatal morbidity and mortality.
- Despite interventions like antenatal corticosteroids and tocolytics, preterm birth rates are increasing.
- Tertiary interventions have shown limited success in reducing the overall incidence of preterm birth.
Purpose of the Study:
- To review the evidence on progesterone's effectiveness in reducing preterm birth.
- To evaluate recent studies on progesterone for preterm birth prevention.
- To define current indications for progesterone administration in pregnancy.
Main Methods:
- Systematic review of existing literature.
- Analysis of recent clinical studies and trials.
- Evaluation of progesterone's efficacy in specific patient groups.
Main Results:
- Prophylactic progesterone shows promise in reducing preterm birth rates.
- Effectiveness is suggested in women with a history of spontaneous preterm birth.
- A short cervical length (≤15 mm) identified via transvaginal scan is another key indication.
Conclusions:
- Progesterone should be offered to women with a history of spontaneous preterm birth (<37 weeks).
- Women with a mid-trimester cervical length of 15 mm or less are candidates for progesterone therapy.
- Further studies are required to assess progesterone's efficacy for other preterm birth risk factors.
Purpose Of Review:
This review summarizes the evidence of the effectiveness of progesterone on the rate of preterm birth and evaluates the most recent studies.
Recent Findings:
The incidence of preterm delivery is about 7-11% of all pregnant women and preterm birth is one of the most important causes of neonatal morbidity and mortality. Interventions to reduce such complications have been attempted for several years. Most efforts so far have been tertiary interventions, such as treatment with antenatal corticosteroids, tocolytic agents, and antibiotics. Some of these measures have reduced perinatal morbidity and mortality, but the incidence of preterm birth is increasing. Recently, researches have suggested prophylactic progesterone could reduce the preterm birth rate in a select group presenting previous preterm birth and a short cervical length by transvaginal scan at mid-trimester pregnancy.
Summary:
This review intends to define the current indication for administration of progesterone for pregnant women. On the basis of current knowledge, progesterone should be offered to women with a documented history of a previous spontaneous birth at less than 37 weeks and for those found to have a short cervical length of 15 mm or less. Studies are needed to evaluate progesterone efficacy on other risk factors.
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