Prenatal administration of vaginal progesterone and frequency of uterine contractions in asymptomatic twin pregnancies

Oliveira, Lília A.M.L de; Brizot, Maria de Lourdes; Liao, Adolfo Wenjaw; Bittar, Roberto Eduardo; Francisco, Rossana Pulcineli Vieira; Zugaib, Marcelo

doi:10.1111/aogs.12843

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…A prospective cohort involving 341 patients with CL measurement between 18 and 21 weeks, described CL mean (31.95-33.46 mm) with 68.2% of PTB < 37 weeks. 14 However, when compared with an Italian cohort study that involved 904 twin gestations with a slightly higher CL median (35.4 vs. 38 mm), our study presented a considerably higher incidence of PTB (PTB < 32 weeks, 14.6 vs. 8.3%), which raises the possibility that other factors could be more important to influence the preterm delivery rate in twins, especially when we consider different populations. 15 Thus, before defining what is a short cervix (and its association with sPTB) in a Brazilian twin population it is crucial to know the CL distribution curve in this specific subset of women.…”

Section: Discussioncontrasting

confidence: 58%

The Use of Mid-Pregnancy Cervical Length to Predict Preterm Birth in Brazilian Asymptomatic Twin Gestations

Silva,

Borovac-Pinheiro,

França

et al. 2023

Rev Bras Ginecol Obstet

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Objective To describe a reference curve for cervical length (CL) in mid-trimester twin gestations using transvaginal ultrasound (TVU) and to investigate whether short CL increases spontaneous preterm birth (sPTB) in asymptomatic twin pregnancies. Methods This was a prospective cohort study performed at 17 outpatient antenatal facilities of Brazil with women at 18 0/7 to 22 6/7 weeks of gestation who participated in a randomized clinical trial screening phase (P5 trial) between July 2015 and March 2019. TVU was performed to provide CL measurement in all screened women. Almost all women with CL ≤ 30 mm received vaginal progesterone 200mg/day and they were also randomized to receive cervical pessary or not. We considered data from the CL distribution among asymptomatic twin pregnancies and analyzed CL and its association with PTB generating receiver operating characteristics (ROC) curves and Kaplan-Meier curves. Results A total of 253 pregnant women with twins were included in the distribution curve. The mean CL was 33.7 mm and median was 35.5mm. The 10th percentile was 17.8mm. We identified a PTB rate of 73.9% (187/253) with 33.6% of sPTB < 37 (85/253) and 15% (38/253) of sPTB < 34 weeks. The best cutoff point to predict sPTB < 37 was 24.15 mm. However, the ROC curve showed a poor performance (0.64). The Kaplan-Meier survival curves identified that only CL values ≤ 20mm were associated to sPTB < 34 weeks. Conclusion A cutoff point of CL ≤ 20 mm can be interesting point to identify short cervix in Brazilian twin pregnancies. However, in Brazilian asymptomatic twin pregnancies, CL does not show a good performance to predict PTB.

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Section: Discussioncontrasting

confidence: 58%

The Use of Mid-Pregnancy Cervical Length to Predict Preterm Birth in Brazilian Asymptomatic Twin Gestations

Silva,

Borovac-Pinheiro,

França

et al. 2023

Rev Bras Ginecol Obstet

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“…A number of studies with small sample sizes have suggested that progesterone use in singleton pregnancies in women with a history of preterm birth, or a short cervix, can be effective in reducing the risk of preterm labor, provided onset of labor has not occurred at doses ranging from 100 to 400 mg/d from mid-gestation onward. [4][5][6][7][8][9][10] Once arrested preterm labor begins, progesterone is no longer effective at delaying birth. 2,3,11 Recently, a large double-blind, placebo-controlled trial known as the OPPTIMUM trial with 587 neonates in the placebo versus 589 in the progesterone groups showed that there was no effect of vaginal progesterone on gestational age at the time of delivery in singleton pregnancies.…”

Section: Introductionmentioning

confidence: 99%

“…12 Similarly, the PREDICT trial, also double blind and placebo controlled, found that vaginal progesterone treatment had no effect on preterm delivery in twin pregnancies, which is in line with previous studies in twin studies. 10,13 Prophylactic use of progestogens during pregnancy continues to be popular, despite the conflicting results from previous trials and the lack of knowledge regarding the effects on the unborn fetus, in particular the effects on fetal steroid profiles. In vivo cholesterol is metabolized into pregnenolone and then into progesterone by the enzymes p450scc and 3b-hydroxysteroid dehydrogenase.…”

Section: Introductionmentioning

confidence: 99%

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Administration of Progesterone Throughout Pregnancy Increases Maternal Steroids Without Adverse Effect on Mature Oligodendrocyte Immunostaining in the Guinea Pig

et al. 2018

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Progesterone is administered to pregnant women at risk of premature labor, despite systematic reviews showing conflicting outcomes regarding its use, highlighting doubt over the effectiveness of the therapy. Progesterone can be rapidly metabolized into a number of steroids, but to date, there has been a lack of investigation into the fetal steroid profiles following administration and whether this impacts fetal neurodevelopment. The objective of this study was to determine the effect of progesterone treatment on allopregnanolone and cortisol levels in the fetus and on a marker of myelination in the fetal brain. We used a guinea pig model where pregnant dams were administered vehicle (β-cyclodextrin) or progesterone orally throughout pregnancy (GA29-61). Maternal and fetal fluids and tissues were collected at both preterm (GA61) and term (GA68) ages. Maternal and fetal progesterone and cortisol were analyzed by enzyme immunoassay and allopregnanolone by radioimmunoassay. Measurement of myelination of fetal brains (hippocampus, cingulum, and subcortical white matter) at preterm and term ages was performed by immunohistochemistry staining for myelin basic protein. We found that dams receiving progesterone had significantly elevated progesterone and cortisol concentrations, but there was no effect on allopregnanolone. Interestingly, the increased cortisol concentrations were not reflected in the fetuses, and there was no effect of progesterone treatment on myelination. Therefore, we conclude that in our guinea pig model, maternal administration of progesterone has no effect on cortisol levels or markers of mature oligodendrocytes in the fetus and suggest this is potentially due to the protective cortisol barrier in the placenta.

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Prenatal administration of progestogens for preventing spontaneous preterm birth in women with a multiple pregnancy

Dodd

Grivell

O’Brien

et al. 2017

Cochrane Database of Systematic Reviews

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Prenatal administration of vaginal progesterone and frequency of uterine contractions in asymptomatic twin pregnancies

Abstract: Overall, progesterone does not influence the frequency of uterine contractions in twin pregnancies.

Cited by 7 publications

References 30 publications

The Use of Mid-Pregnancy Cervical Length to Predict Preterm Birth in Brazilian Asymptomatic Twin Gestations

The Use of Mid-Pregnancy Cervical Length to Predict Preterm Birth in Brazilian Asymptomatic Twin Gestations

Administration of Progesterone Throughout Pregnancy Increases Maternal Steroids Without Adverse Effect on Mature Oligodendrocyte Immunostaining in the Guinea Pig

Prenatal administration of progestogens for preventing spontaneous preterm birth in women with a multiple pregnancy

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