Progesterone for the prevention of preterm birth: indications, when to initiate, efficacy and safety

How, Helen; Sibai, Bahaeddine M

doi:10.2147/tcrm.s1567

Cited by 26 publications

(30 citation statements)

References 96 publications

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“…Vaginal administration of natural progesterone keeps undesirable systemic effects of treatment to a minimum, and does not affect either maternal weight or embryo-fetal viability, or cause malformation [30,50]. However, synthetic progestogens, such as 17 OHP-C, have been associated with a less favorable tolerability profile [51,52]. Side effects reported in the literature include pain, swelling, pruritis and nodule formation at the injection site, urticaria, nausea and vomiting, mood swings, bloating, abdominal pain, depression, nervousness, sleep disorder and tiredness, dizziness, fever, flu-like symptoms, upper respiratory infection, urinary tract infection, yeast infection, asthma, acne and pain in the joints, back and leg [29,52].…”

Section: Safetymentioning

confidence: 99%

“…However, synthetic progestogens, such as 17 OHP-C, have been associated with a less favorable tolerability profile [51,52]. Side effects reported in the literature include pain, swelling, pruritis and nodule formation at the injection site, urticaria, nausea and vomiting, mood swings, bloating, abdominal pain, depression, nervousness, sleep disorder and tiredness, dizziness, fever, flu-like symptoms, upper respiratory infection, urinary tract infection, yeast infection, asthma, acne and pain in the joints, back and leg [29,52]. Weekly 17 OHP-C prophylaxis has also been linked with an increased risk of gestational diabetes mellitus in women with a history of spontaneous preterm birth (odds ratio 2.9, 95% CI 2.1-4.1) [53].…”

Section: Safetymentioning

confidence: 99%

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The role of progesterone in maternal and fetal medicine

Renzo

Giardina

Clerici

et al. 2012

Gynecological Endocrinology

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Progesterone is an essential hormone in the process of reproduction. It has been extensively studied in the treatment of different gynecological pathologies, as a contraceptive and in assisted reproductive technologies. However, the use of progesterone in the pathophysiology of pregnancy remains controversial. Progesterone, and its synthetic form 17 α-hydroxyprogesterone caproate (17 OHP-C), offer an effective intervention when the continuation of pregnancy is at risk from immunological factors, luteinic and neuroendocrine deficiencies, and myometrial hypercontractility. Progesterone has been successfully used as prophylaxis in the prevention of spontaneous miscarriage, with treatment beginning from the first trimester of pregnancy. There is substantial evidence, too, to indicate that women with idiopathic recurrent miscarriage may benefit from the immunomodulatory properties of progesterone in early pregnancy. The use of progesterone and 17 OHP-C has been extensively studied in the prevention of preterm birth in a variety of settings. Transvaginal ultrasound measurement of cervical length in singleton pregnancies between 19 and 24 weeks' gestation has been deemed the best way to identify women (approximately 2% of the pregnant population) who would benefit from prophylactic progesterone treatment for the prevention of spontaneous preterm birth. This paper reviews the evidence for the safety and efficacy of the use of progesterone in each of these indications.

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Section: Safetymentioning

confidence: 99%

Section: Safetymentioning

confidence: 99%

The role of progesterone in maternal and fetal medicine

Renzo

Giardina

Clerici

et al. 2012

Gynecological Endocrinology

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“…Progesterone is one of the few proven effective methods to prevent PTB in women with previous history of spontaneous PTB and in women with short cervical length [25]. The role and mechanism of progesterone in preventing PTB is not fully understood; it is known to relax the uterine smooth muscle, inhibition of oxytocin effects on the myometrium, and the formation of myometrial gap junction [10]. It has also been shown to regulate uterine contractility and prevent cervical ripening, which may play a role in onset of labor.…”

Section: Discussionmentioning

confidence: 99%

“…For more than 30 years, progesterone administration has been advocated for the prevention of PTB in women considered to be at high risk for PTB [9]. However, the results of the earlier studies on the efficacy and safety of this treatment were controversial [10]. In 2004, two randomized controlled trials suggested that the prophylactic administration of progesterone in pregnant women at high risk for PTB, including those with prior history of PTB, is associated with a reduction of 60% to 78% in PTB rate [11,12].…”

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confidence: 99%

Vaginal micronized natural progesterone treatment and reduced risk of recurrent preterm birth

성지현

김민지

이예리

et al. 2012

Korean J Obstet Gynecol

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Preterm birth (PTB) is defined as birth before 37 completed weeks of gestation, which occurs in approximately 10% of all pregnancies [1]. PTB causes about 70% of all neonatal deaths of nonanomalous infants, as well as neonatal morbidities including respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia and long-term complications such as cerebral palsy [2,3]. The PTB rate has risen worldwide, and in South Korea, the PTB rate has also risen from 4.3% in 1995 to 10% in 2003 [1,4]. There are many known risk factors for PTB, but one of the most ObjectiveTo evaluate whether the administration of vaginal natural micronized progesterone is associated with reduction of recurrent preterm birth (PTB) in women with prior history of spontaneous PTB. MethodsWe retrospectively evaluated the obstetric and neonatal outcomes of all women with history of spontaneous PTB that delivered from January 2008 through April 2012. Spontaneous PTB was defined as PTB before 37 weeks of gestation due to spontaneous preterm labor or preterm premature rupture of membranes. Pregnancies with multiple gestation and those who received cerclage operation during previous or current pregnancy were excluded. Patients in the progesterone group were instructed to selfadminister 100 or 200 mg vaginal micronized natural progesterone capsule. We evaluated the difference in recurrent PTB rate between the progesterone group (n = 73) and the non-user group (n = 158). ResultsThe incidence of recurrent spontaneous PTB before 37 weeks' gestation was significantly lower in the progesterone group than the non-user group (21.9% vs. 43.0%, P=0.002). Multivariate analysis showed that progesterone therapy was associated with a decrease in the incidence of recurrent PTB before 37 weeks' gestation (odds ratio, 0.382; 95% confidence interval, 0.169-0.863; P=0.021) independent of confounding variables. ConclusionMicronized vaginal progesterone supplement therapy was associated with a reduction of recurrent PTB risk in women with previous spontaneous PTB history.

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“…En estos grupos se vio una disminución estadísticamente significativa en el riesgo de neonatos con peso menor de 2.500 g. Sin embargo, para otras intervenciones, se desconoce el rol de la progesterona en mujeres que presentaron síntomas o signos de amenaza de parto pretérmino y gestantes con otros factores de riesgo para parto pretérmino (11). Se requiere mayor información para conocer la ruta de administración, la dosis y el mejor momento para el inicio de la progesterona (11,12).…”

Section: • Compromiso Fetal O Insuficiencia Placentariaunclassified

Guía fármacoterapeutica de amenaza de parto pretérmino

Osorio

Garcia

2015

Rev. Colomb. Enferm.

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RESUMENEl parto pretérmino representa un reto terapéutico ya que su tratamiento oportuno disminuye la morbilidad y mortalidad neonatal. Afecta de 5 a 11% de todos los partos en el mundo, entre 9 y 10% en países de bajos ingresos y de 6 a 11,9% en países con altos ingresos. Es el responsable de 70% de las muertes neonatales y 37% de las muertes en infantes así como el causante de 25 a 50% de los casos de falla en el desarrollo neurológico en niños. Por lo anterior, es importante realizar un adecuado tamizaje y tratamiento de las pacientes que se encuentran en riesgo de parto pretérmino. Para ello, se realizó una guía fármacoterapeutica basada en la mejor evidencia para su manejo.Palabras clave: parto pretérmino, magnesio, esteroides, progesterona, tocólisis. Artículo de RevisiónGuía fármacoterapeutica de amenaza de parto pretérmino ABSTRACT preterm labor represents a therapeutic challenge because opportune treatment decreases neonatal morbidity and mortality. It affects 5-11% of all worldwide births. Of these births 9-10% occurred in low-income countries and 6-11.9% in high-income countries. Preterm labor is responsible for 70% of neonatal deaths and 37% of infant deaths; it causes 25-50% of the cases of neurological development failure in children. Because of this, it is important to perform adequate screening and treatment of patients at risk for preterm delivery. A pharmaceutical guide based on the best evidence for its management was performed.Key words: premature birth, magnesium, steroids, progesterone, tocolysis. RESUMOO parto prematuro representa um desafio terapêutico, uma vez que seu tratamento oportuno diminui a morbidez e mortalidade neonatal. Afeta de 5 a 11% de todos os partos no mundo, sendo que, entre 9 e 10% ocorrem em países de baixa renda, e de 6 a 11,9%, em países de alta renda. É responsável por 70% das mortes neonatais e 37% das mortes em recém-nascidos, assim como é o causador de 25 a 50% dos casos de falha no desenvolvimento neurológico em crianças. Por este motivo, é importante realizar uma triagem e tratamento adequados das pacientes que se encontram em risco de parto prematuro. Portanto, foi elaborado um guia farmacoterapêutico com base na melhor evidência para seu manuseio.Palavras-chave: parto prematuro, magnésio, esteroides, progesterona, tocólise.

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Progesterone for the prevention of preterm birth: indications, when to initiate, efficacy and safety

Cited by 26 publications

References 96 publications

The role of progesterone in maternal and fetal medicine

The role of progesterone in maternal and fetal medicine

Vaginal micronized natural progesterone treatment and reduced risk of recurrent preterm birth

Guía fármacoterapeutica de amenaza de parto pretérmino

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