[Indications for Progesterone Use in Populations at Risk of Preterm Birth in 2025]

Vaginal progesterone is currently considered for the prevention of preterm birth (PTB), depending on the patient's risk profile. Among women with a history of PTB but without a short cervix, recent studies are inconsistents and large trials show no benefit. The literature does not support routine prescription, confirming the 2016 French recommendations. Current data are insufficient to determine its use among women with multiple previous spontaneous PTBs or according to the gestational age of the previous PTB. In these cases, women should be offered progesterone prescription in the context of a shared decision-making process. In multiple pregnancies, results are mixed, but no benefit has been shown except when cervical length is<25mm. Data on uterine malformations or fibroid uterus are too limited to draw conclusions. In symptomatic patients (threatened preterm labor or late miscarriage), data are heterogeneous but show no benefit of vaginal progesterone on pregnancy prolongation or neonatal outcomes.