Role of Vaginal Progesterone in Prevention of Preterm Labor in Women with Previous History of One or More Previous Preterm Births

Abstract

Objective: To evaluate whether prophylactic administration of 200 mg vaginal progesterone can reduce the incidence of preterm birth in women with documented history of preterm birth <37 weeks of gestation or not. Setting: Obstetrics and Gynecology Department, Zagazig University Hospital, Egypt. Methods: Ninety patients with previous history of preterm birth prior to 37 week presenting with singleton pregnancy between 20 -24 weeks were randomly allocated to receive either the progesterone 200 mg vaginal suppository or no treatment. Results: The incidence of preterm labor before 37 weeks of gestation was significantly lower in the study group than in the control group (22.2% vs. 53.3%) especially in earlier gestational ages. While, the mean birth weight was significantly higher in the study group than in control group (2872.67 ± 565.76 gm vs. 2487.78 ± 742.40 gm). The neonatal morbidities and mortality associated with preterm labor were significantly lower in the study group than in the control group as shown by lower incidence of neonatal RDS (13.3% vs. 31.1%; P = 0.043) and lower incidence of the need for NICU admission (15.6% vs. 35.5%; P = 0.03). Conclusion: Administration of prophylactic vaginal progesterone (200 mg, daily) can significantly reduce the rate of preterm birth before 37, 32 and 28 wks of gestation among women with previous spontaneous preterm birth. In addition, the rates of RDS and admission to NICU were significantly decreased among infants of women assigned to progesterone treatment. Also, there was an additional benefit of vaginal progesterone for prevention of preterm birth in women who had prior spontaneous preterm birth and cervical length < 25 mm.

Assessment of efficacy of micronized progesterone by vaginal route for prevention of preterm labour

“…It was observed in the present study that 21(40%) patients had preterm delivery and the mean gestational age at delivery was 35.5±2.5 weeks in the progesterone group. This finding was consistent with the studies of Patra K et al [14] , Wajid R et al [15] and Abdou AM [16] .…”

“…In our study, 12(23%) neonates had low birth weight (<2.5kg), while 7(13%) neonates were admitted in NICU. This is comparable to the studies of Patra K et al [14] , Ashoush S et al [12] , Choudhary M et al [17] , Khan S et al [18] and Abdou AM, [16] . In our study, the mean birth weight was significantly higher in the progesterone group as compared to the placebo group [2432±50 gm versus 1978±70 gm, p=0.000].…”

“…In our study, the mean birth weight was significantly higher in the progesterone group as compared to the placebo group [2432±50 gm versus 1978±70 gm, p=0.000]. This is comparable to the study of Abdou AM [16] .…”

The Efficacy of Vaginal Progesterone in Reducing Preterm Birth in High-Risk Pregnancies

“…Even with a shorter cervical length than we reported in our study [mean was 36 mm in our study], vaginal progesterone achieve a statically significant effect difference between study group and control group according to preterm labor. Data were available from 974 women in [17] A.Abdou et al [18] showed that the administration of vaginal suppository progesterone [200 mg, daily] beginning at 20 -24 wks of gestation and continued to 36 wks of gestation can significantly reduce the rate of preterm birth before 37, 32 and 28 wks of gestation among women with previous spontaneous preterm birth specially in earlier gestational ages and increase the mean birth weight. In addition, the rates of RDS and admission to NICU were significantly decreased among infants of women assigned to progesterone treatment.…”

Oral Micronized or Parenteral Progesterone versus Health Education in the Prevention of Preterm Birth: A Single Blinded Randomized Controlled Trial

“…Centrally, vaginal progesterone was proved to be significantly effective for prevention of PTB in high risk cases [12]. Currently, no evidence exists on which progesterone supplementation can maximize the preventative effects while minimizing the side effects.…”