The Effects of Progesterone Therapy on the Gestation Length and Reduction of Neonatal Complications in Patients who had Received Tocolytic Therapy for Acute Phase of Preterm Labor

Abstract

BackgroundWhile tocolytic therapy can halt the process of delivery, some patients return before the 37th week of pregnancy with recurrence of preterm labor signs.ObjectivesThis study was designed to evaluate the efficacy of progesterone in the prolonging of gestation and reduction of neonatal complications.Material and MethodsIn a clinical trial in 2010, 110 singleton pregnant women admitted at Imam Reza Hospital, Mashhad, Iran, with the diagnosis of preterm labor were divided into three groups: 400 mg/d vaginal progesterone suppositories; 250 mg/w 17-alpha-hydroxyl-progestrone-caproate; and a control group with no additional treatment. After delivery, we assessed the duration between the first phases of labor to the recurrence of preterm labor. The neonatal complications, apgar score, birth weight, need for admission to NICU, and congenital malformations were compared between groups.ResultsThe mean gestational age was 34± 3 weeks in the first, 33.5 ± 3 weeks in the second and 32.5 ± 2 weeks in the control group. The duration of first phase of labor was 31 ± 17 days in the first, 36 ± 14 days in the second and 26 ± 22 days in the control group. The difference between study groups and the control group was significant (P < 0.005). The complications were lower in progesterone-receiving group in comparison to the control group.DiscussionThis study reveals that progesterone can significant reduce the rate of recurrent preterm labor and the several possible neonatal complications among women who had treated with tocolytics to suppress the acute phase.

Effect of vaginal progesterone in tocolytic therapy during preterm labor in twin pregnancies: Secondary analysis of a placebo‐controlled randomized trial

“…In five studies involving singleton pregnancies, vaginal progesterone was introduced during or after tocolytic therapy; whereas in the present study, patients were already using progesterone when PTL occurred and tocolytic therapy was introduced. Therefore, we infer that this could have diminished the effect of progesterone, because of a possible tolerance effect.…”

“…Therefore, it is possible that higher doses of progesterone would be needed for use in twin pregnancies to achieve the effect observed in singleton pregnancies. The progesterone dosage used in the studies involving singleton pregnancies varied from 200 to 400 mg and there was no difference observed in the latency to delivery …”

“…Therefore, the effect of the progesterone depends on the associated tocolytic used. The specific tocolytic drugs used in previous studies varied (atosiban, magnesium sulfate, ritodrine or nifedipine); therefore, it is difficult to draw conclusions regarding the performance of progesterone in combination with specific tocolytic drugs. We found only one study that investigated the use of atosiban in combination with vaginal progesterone.…”

17OHP‐C in patients with spontaneous preterm labor and intact membranes: is there an effect according to the presence of intra‐amniotic inflammation?

“…6 In addition, a similar clinical study showed that 17OHP-C did not reduce the frequency of PTB in nulliparous women with midtrimester cervical length <30 mm. [9][10][11][12][13] According to this review, although an improvement in neonatal prognosis was not observed, the gestational period was significantly prolonged (8.36 days) by 17OHP-C treatment. [9][10][11][12][13] According to this review, although an improvement in neonatal prognosis was not observed, the gestational period was significantly prolonged (8.36 days) by 17OHP-C treatment.…”

“…7 On the other hand, the effect of 17OHP-C for preventing preterm delivery with an episode of preterm labor (PTL) with intact membranes is not well recognized, but there is one review 8 summarizing five clinical reports. [9][10][11][12][13] According to this review, although an improvement in neonatal prognosis was not observed, the gestational period was significantly prolonged (8.36 days) by 17OHP-C treatment. However, there is a lack of knowledge about the mechanisms by which 17OHP-C reduces PTB [14][15][16] in singleton pregnant women with a history of PTB.…”