17‐alpha‐hydroxyprogesterone caproate versus vaginal progesterone suppository for the prevention of preterm birth in women with a sonographically short cervix: A randomized controlled trial

Pirjani, Reihaneh; Heidari, Reza; Rahimiforoushani, Abbas; Bayesh, Seyedehsara; Esmailzadeh, Arezoo

doi:10.1111/jog.13151

Cited by 13 publications

(15 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[44][45][46][47] One study compared cerclage (McDonald) with progesterone (IM 17-OHPC) 48 and six studies compared PV progesterone with IM 17-OHPC. [49][50][51][52][53][54] Only four studies included women with a previous preterm birth excluding those with a short cervix (defined as <15, <20, <25, and <28 mm), and three studies included women with a short cervix excluding those with a history of preterm birth (including one study with women with a cervical length of <30 mm). Twelve studies included women with a previous preterm birth, regardless of cervical length, and ten studies included women with a short cervix (usually defined as ≤25 mm, although one study included women with a cervical length of <30 mm), regardless of their preterm birth history.…”

Section: Study Characteristicsmentioning

confidence: 99%

Vaginal progesterone, oral progesterone, 17‐OHPC, cerclage, and pessary for preventing preterm birth in at‐risk singleton pregnancies: an updated systematic review and network meta‐analysis

Jarde

Lutsiv²,

Beyene

et al. 2018

BJOG

123

View full text Add to dashboard Cite

Background Recent progesterone trials call for an update of previous syntheses of interventions to prevent preterm birth.Objectives To compare the relative effects of different types and routes of administration of progesterone, cerclage, and pessary at preventing preterm birth in at-risk women overall and in specific populations.Search strategy We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL, and Web of Science up to 1 January 2018.Selection criteria We included randomised trials of progesterone, cerclage or pessary for preventing preterm birth in at-risk singleton pregnancies.Data collection and analysis We used a piloted data extraction form and performed Bayesian random-effects network metaanalyses with 95% credibility intervals (CrI), as well as pairwise meta-analyses, rating the quality of the evidence using GRADE.Main results We included 40 trials (11 311 women). In at-risk women overall, vaginal progesterone reduced preterm birth <34 (OR 0.43, 95% CrI 0.20-0.81) and <37 weeks (OR 0.51, 95% CrI 0.34-0.74), and neonatal death (OR 0.41, 95% CrI 0.20-0.83). In women with a previous preterm birth, vaginal progesterone reduced preterm birth <34 (OR 0.29, 95% CI 0.12-0.68) and <37 weeks (OR 0.43, 95% CrI 0.23-0.74), and 17ahydroxyprogesterone caproate reduced preterm birth <37 weeks (OR 0.53, 95% CrI 0.27-0.95) and neonatal death (OR 0.39, 95% CI 0.16-0.95). In women with a short cervix (≤25 mm), vaginal progesterone reduced preterm birth <34 weeks (OR 0.45, 95% CI 0.24-0.84). ConclusionsVaginal progesterone was the only intervention with consistent effectiveness for preventing preterm birth in singleton atrisk pregnancies overall and in those with a previous preterm birth.

show abstract

Section: Study Characteristicsmentioning

confidence: 99%

Vaginal progesterone, oral progesterone, 17‐OHPC, cerclage, and pessary for preventing preterm birth in at‐risk singleton pregnancies: an updated systematic review and network meta‐analysis

Jarde

Lutsiv²,

Beyene

et al. 2018

BJOG

123

View full text Add to dashboard Cite

show abstract

“…The vaginal progesterone group had significantly lower rates of PTB <34 weeks of gestation, PTB at 28 to 32 weeks of gestation, and a lower rate of side effects. However, randomized trials comparing daily vaginal progesterone administration and weekly intramuscular injection of 250 mg of 17α-OHPC in singleton pregnant women with history of PTB or short CL did not show any significant differences in the rate of PTB <37 weeks of gestation, mean GAD, and neonate outcomes between the 2 groups [ 74 75 76 ]. A recent systematic review and meta-analysis showed that women who received vaginal progesterone had significantly lower rates of PTB <34 and <32 weeks of gestation, a lower rate of adverse drug reactions and a lower rate of NICU admission compared with women who received 17α-OHPC [ 77 ].…”

Section: Ohcp Intramuscular Injection Versus Vaginal Natural Micronmentioning

confidence: 99%

Use of progesterone supplement therapy for prevention of preterm birth: review of literatures

Choi

2017

Obstet Gynecol Sci

View full text Add to dashboard Cite

Preterm birth (PTB) is one of the most common complications during pregnancy and it primarily accounts for neonatal mortality and numerous morbidities including long-term sequelae including cerebral palsy and developmental disability. The most effective treatment of PTB is prediction and prevention of its risks. Risk factors of PTB include history of PTB, short cervical length (CL), multiple pregnancies, ethnicity, smoking, uterine anomaly and history of curettage or cervical conization. Among these risk factors, history of PTB, and short CL are the most important predictive factors. Progesterone supplement therapy is one of the few proven effective methods to prevent PTB in women with history of spontaneous PTB and in women with short CL. There are 2 types of progesterone therapy currently used for prevention of PTB: weekly intramuscular injection of 17-alpha hydroxyprogesterone caproate and daily administration of natural micronized progesterone vaginal gel, vaginal suppository, or oral capsule. However, the efficacy of progesterone therapy to prevent PTB may vary depending on the administration route, form, dose of progesterone and indications for the treatment. This review aims to summarize the efficacy and safety of progesterone supplement therapy on prevention of PTB according to different indication, type, route, and dose of progesterone, based on the results of recent randomized trials and meta-analysis.

show abstract

“…We identified five randomised controlled trials that compared vaginal progesterone and IM progestin for the prevention of PTB in singleton pregnant women with history of PTB or short CL (Table S5). 27–31 Daily gel (90 mg) was used for vaginal progesterone in one study, 27 and daily tablets (100‒400 mg) were used for vaginal progesterone in the other four studies 28–31 . The weekly administration of 250 mg 17‐OHPC was used for IM progestin in all studies.…”

Section: Resultsmentioning

confidence: 99%

“…We found that the efficacy of vaginal and IM progestogen therapies was equivalent in preventing PTB in women with a history of spontaneous PTB or short CL, however, consistent with previous studies (Table S5). 28–31 …”

Section: Discussionmentioning

confidence: 99%

Vaginal compared with intramuscular progestogen for preventing preterm birth in high‐risk pregnant women (VICTORIA study): a multicentre, open‐label randomised trial and meta‐analysis

Choi

Kwak

Kil

et al. 2020

BJOG

View full text Add to dashboard Cite

Objective To compare the efficacy of two types of progestogen therapy for preventing preterm birth (PTB) and to review the relevant literature. Design A multicentre, randomised, open‐label, equivalence trial and a meta‐analysis. Setting Tertiary referral hospitals in South Korea. Population Pregnant women with a history of spontaneous PTB or short cervical length (<25 mm). Methods Eligible women were screened and randomised at 16‒22 weeks of gestation to receive either 200 mg of vaginal micronised progesterone daily (vaginal group) or an intramuscular injection of 250 mg 17α‐hydroxyprogesterone caproate weekly (IM group). Stratified randomisation was carried out according to participating centres and indications for progestogen therapy. This trial was registered at https://ClinicalTrials.gov (NCT02304237). Main outcome measure Preterm birth (PTB) before 37 weeks of gestation. Results A total of 266 women were randomly assigned and a total of 247 women (119 and 128 women in the vaginal and IM groups, respectively) were available for the intention‐to‐treat analysis. Risks of PTB before 37 weeks of gestation did not significantly differ between the two groups (22.7 versus 25.8%, P = 0.571). The difference in PTB risk between the two groups was 3.1% (95% CI −7.6 to 13.8%), which was within the equivalence margin of 15%. The meta‐analysis results showed no significant differences in the risk of PTB between the vaginal and IM progestogen treatments. Conclusion Compared with vaginal progesterone, treatment with intramuscular progestin might increase the risk of PTB before 37 weeks of gestation by as much as 13.8%, or reduce the risk by as much as 7.6%, in women with a history of spontaneous PTB or with short cervical length. Tweetable abstract Vaginal and intramuscular progestogen showed equivalent efficacy for preventing preterm birth before 37 weeks of gestation.

show abstract

17‐alpha‐hydroxyprogesterone caproate versus vaginal progesterone suppository for the prevention of preterm birth in women with a sonographically short cervix: A randomized controlled trial

Abstract: Our findings showed that vaginal progesterone and 17OHP-C had the same effect on the risk of preterm labor in asymptomatic women with a sonographically short cervix. We detected no significant difference between the effect of 17OHP-C and vaginal progesterone on CL changes over time.

Cited by 13 publications

References 23 publications

Vaginal progesterone, oral progesterone, 17‐OHPC, cerclage, and pessary for preventing preterm birth in at‐risk singleton pregnancies: an updated systematic review and network meta‐analysis

Vaginal progesterone, oral progesterone, 17‐OHPC, cerclage, and pessary for preventing preterm birth in at‐risk singleton pregnancies: an updated systematic review and network meta‐analysis

Use of progesterone supplement therapy for prevention of preterm birth: review of literatures

Vaginal compared with intramuscular progestogen for preventing preterm birth in high‐risk pregnant women (VICTORIA study): a multicentre, open‐label randomised trial and meta‐analysis

Contact Info

Product

Resources

About