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Progesterone and preterm birth.

Jane E Norman1

  • 1Faculty of Health Sciences, University of Bristol, Bristol, UK.

International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics
|June 12, 2020
PubMed
Summary
This summary is machine-generated.

Progestogens are recommended for preventing preterm birth, but evidence for their effectiveness is conflicting. Further research, including a large meta-analysis, is needed to clarify their benefits and long-term effects.

Keywords:
17-Hydroxyprogesterone acetatePreterm birthPreterm laborPreventionProgesterone

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Pharmacology

Background:

  • Progestogens, including vaginal progesterone and intramuscular 17-hydroxyprogesterone acetate, are standard recommendations for high-risk pregnancies.
  • Current guidelines suggest specific regimens based on gestational week and patient history.

Purpose of the Study:

  • To critically review the evidence on the efficacy, impact, and long-term effects of progestogen use for preterm birth prevention.
  • To address conflicting findings from major clinical trials and provide clarity for clinicians and patients.

Main Methods:

  • Systematic review and critical assessment of existing randomized controlled trials and meta-analyses.
  • Evaluation of data from large-scale trials such as PROLONG and OPPTIMUM.
  • Analysis of cost-effectiveness data and projected impact on preterm birth rates.

Main Results:

  • Major trials like PROLONG and OPPTIMUM did not demonstrate clear efficacy for 17-hydroxyprogesterone acetate or vaginal progesterone.
  • Limited data exists on the long-term effects of progestogens beyond the neonatal period.
  • The reduction in preterm birth rates with cervical length screening and progesterone is minimal (<0.5%).

Conclusions:

  • The efficacy of progestogens for preterm birth prevention remains uncertain due to conflicting trial results.
  • Further clarification is anticipated from an upcoming individual patient data meta-analysis funded by PCORI.
  • Current recommendations may require re-evaluation based on comprehensive evidence of efficacy and long-term outcomes.