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Progesterone for the Prevention of Preterm Birth - an Update of Evidence-Based Indications
Ruben-J Kuon1, Pauline Voß1, Werner Rath2
1Universitätsklinikum Heidelberg, Abteilung für Gynäkologische Endokrinologie und Fertilitätsstörungen, Frauenklinik, Heidelberg, Germany.
Insights
Vaginal progesterone effectively prevents preterm birth in asymptomatic singleton pregnancies with short cervix. It also shows promise for twin pregnancies, but recommendations for those with a history of preterm birth require individualized assessment.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Pharmacology
Background:
- Preterm birth affects 11% of newborns globally, posing significant challenges.
- Progesterone's potential role in preventing preterm birth is supported by experimental data.
- Clinical trial heterogeneity complicates comparisons and evidence-based recommendations.
Purpose of the Study:
- To critically evaluate existing literature on progestogen use for preterm birth prevention.
- To provide evidence-based recommendations for progesterone administration in pregnancy.
Main Methods:
- Comprehensive literature search from 1956 to September 2018.
- Focus on randomized controlled trials.
- Critical evaluation of study inclusion criteria, progestogen types, and administration methods.
Main Results:
- Vaginal progesterone (200mg capsule or 90mg gel) significantly reduces preterm birth and improves neonatal outcomes in asymptomatic singleton pregnancies with cervical length ≤25mm before 24 weeks of gestation (WG).
- Positive effects of progesterone are suggested for twin pregnancies with short cervical length (≤25mm) before 24 WG.
- Data for singleton pregnancies with a prior preterm birth are heterogeneous, precluding general recommendations.
Conclusions:
- Vaginal progesterone is recommended for specific high-risk singleton pregnancies.
- Progesterone may benefit selected twin pregnancies with short cervix.
- Individualized patient selection is crucial for effective and safe progesterone use in preterm birth prevention.
Abstract:
The prevention and treatment of preterm birth remains one of the biggest challenges in obstetrics. Worldwide, 11% of all children are born prematurely with far-reaching consequences for the children concerned, their families and the health system. Experimental studies suggest that progesterone inhibits uterine contractions, stabilises the cervix and has immunomodulatory effects. Recent years have seen the publication of numerous clinical trials using progestogens for the prevention of preterm birth. As a result of different inclusion criteria and the use of different progestogens and their methods of administration, it is difficult to draw comparisons between these studies. A critical evaluation of the available studies was therefore carried out on the basis of a search of the literature (1956 to 09/2018). Taking into account the most recent randomised, controlled studies, the following evidence-based recommendations emerge: In asymptomatic women with singleton pregnancies and a short cervical length on ultrasound of ≤ 25 mm before 24 weeks of gestation (WG), daily administration of vaginal progesterone (200 mg capsule or 90 mg gel) up until 36 + 6 WG leads to a significant reduction in the preterm birth rate and an improvement in neonatal outcome. The latest data also suggest positive effects of treatment with progesterone in cases of twin pregnancies with a short cervical length on ultrasound of ≤ 25 mm before 24 WG. The study data for the administration of progesterone in women with singleton pregnancies with a previous preterm birth have become much more heterogeneous, however. It is not possible to make a general recommendation for this indication at present, and decisions must therefore be made on a case-by-case basis. Even if progesterone use is considered to be safe in terms of possible long-term consequences, exposure should be avoided where it is not indicated. Careful patient selection is crucial for the success of treatment.
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