Technical Update No. 467: Progesterone for Previous Spontaneous Preterm Birth.

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Neonatal Health

Background:

• Spontaneous preterm birth (SPB) poses significant risks to neonatal morbidity and mortality.
• Identifying effective interventions to prevent SPB is a critical area of obstetric research.
• Previous spontaneous preterm birth is a primary risk factor for recurrence.

Purpose of the Study:

• To evaluate the efficacy and safety of progesterone therapy for preventing spontaneous preterm birth.
• To assess the impact of progesterone on neonatal and postnatal outcomes.
• To provide evidence-based recommendations for progesterone use in high-risk pregnancies.

Main Methods:

• Systematic review of evidence from major medical databases (Medline, PubMed, EMBASE, Cochrane Library).
• Focus on pregnant women with a history of spontaneous preterm birth.
• Evaluation of progesterone administration versus withholding therapy.
• Assessment of outcomes including preterm birth, neonatal complications, and neurodevelopmental status.
• Quality of evidence and strength of recommendations assessed using the GRADE approach.

Main Results:

• Progesterone therapy demonstrated a significant reduction in spontaneous preterm birth risk in specific subpopulations.
• The therapy is associated with costs and discomfort for the patient.
• No significant adverse effects were identified for the mother or the newborn.

Conclusions:

• Progesterone therapy is beneficial for selected women at increased risk of spontaneous preterm birth.
• Recommendations support its use in women with a short cervix (≤25 mm) between 16-24 weeks gestation.
• It is not recommended for women with a history of SPB and normal cervical length.