Progesterone as a tocolytic agent for preterm labor: a systematic review

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Pharmacology

Background:

• Tocolytic agents are crucial in managing preterm labor, aiming to delay delivery by 48 hours.
• This 48-hour window allows for critical interventions like corticosteroids for fetal lung maturity and magnesium sulfate for neuroprotection.
• Currently, no established therapies exist to sustain tocolytic effects beyond this initial 48-hour period.

Purpose of the Study:

• To review the current landscape of tocolytic agents used in preterm labor management.
• To explore the potential of progesterone as a maintenance tocolytic agent beyond the initial 48-hour window.
• To evaluate the evidence for progesterone's efficacy in prolonging the delay of delivery and improving neonatal outcomes.

Main Methods:

• Review of existing literature on tocolytic agents and preterm birth prevention.
• Analysis of studies investigating progesterone's role in uterine quiescence and tocolysis.
• Examination of meta-analyses assessing progesterone's impact on delivery delay, preterm birth incidence, and neonatal morbidity.

Main Results:

• Progesterone has a long-standing history of use in preventing preterm birth due to its uterine-quieting effects.
• Recent studies and meta-analyses suggest progesterone may be effective for maintenance tocolysis after initial preterm labor arrest.
• Evidence indicates potential benefits in delaying delivery, reducing preterm birth rates, and decreasing neonatal complications.

Conclusions:

• Progesterone is identified as the most promising agent for maintenance tocolysis.
• While studies present conflicting results, meta-analyses show encouraging trends for progesterone's efficacy.
• Further clinical trials are essential to confirm progesterone's role and optimize its use in managing preterm labor.