The prevalence of short cervix between 20 and 24 weeks of gestation and vaginal progesterone for prolonging of gestation

Maerdan, Malipati; Shi, Changhong; Zhang, Xiaoxiao; Fan, Lixin

doi:10.1080/14767058.2016.1220528

Cited by 13 publications

(20 citation statements)

References 11 publications

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“…One limitation of progesterone therapy is that it is applicable to only a small percentage of pregnant women (primarily those with a shortened cervix and those with a history of previous sPTB), so its net benefits on a population basis are limited 4, 42, 48 . Nevertheless, several studies have now confirmed the feasibility of conducting population-based cervical screening programs 28, 34, 49, 50 and have concluded that the cost-effectiveness of such programs combined with progesterone therapy is favourable 49, 51– 54 , although they would clearly be improved if the effectiveness of interventions could be increased 55 .…”

Section: Recent Advancesmentioning

confidence: 99%

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Recent advances in the prevention of preterm birth

Keelan

Newnham

2017

F1000Res

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Preterm birth (PTB) remains a major obstetric healthcare problem and a significant contributor to perinatal morbidity, mortality, and long-term disability. Over the past few decades, the perinatal outcomes of preterm neonates have improved markedly through research and advances in neonatal care, whereas rates of spontaneous PTB have essentially remained static. However, research into causal pathways and new diagnostic and treatment modalities is now bearing fruit and translational initiatives are beginning to impact upon PTB rates. Successful PTB prevention requires a multifaceted approach, combining public health and educational programs, lifestyle modification, access to/optimisation of obstetric healthcare, effective prediction and diagnostic modalities, and the application of effective, targeted interventions. Progress has been made in some of these areas, although there remain areas of controversy and uncertainty. Attention is now being directed to areas where greater gains can be achieved. In this mini-review, we will briefly and selectively review a range of PTB prevention strategies and initiatives where progress has been made and where exciting opportunities await exploitation, evaluation, and implementation.

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Section: Recent Advancesmentioning

confidence: 99%

“…Several lines of evidence suggest that inflammation in the cervix is required for effective vaginal progesterone treatment, which appears to work at least in part through an anti-inflammatory mechanism 45, 48, 56– 58 . Markers of cervical inflammation could, therefore, be employed to target therapy to those at highest risk 59, 60 .…”

Section: Recent Advancesmentioning

confidence: 99%

Recent advances in the prevention of preterm birth

Keelan

Newnham

2017

F1000Res

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“…A number of interventions have been shown to significantly decrease the rate of spontaneous preterm birth (sPTB) including specialist antenatal clinics for women at high risk of PTB [6]; cervical cerclage for women with a previous sPTB and/or a short cervix (< 25 mm) [7,8] and vaginal progesterone for women with cervical length < 25 mm [9][10][11][12][13]. Progesterone decreases uterine contractility through inhibition of production of prostaglandins in the myometrium [14] and has been shown to be important in maintaining a pregnancy until term [15].…”

Section: Introductionmentioning

confidence: 99%

Vaginal progesterone for prevention of preterm birth in asymptomatic high-risk women with a normal cervical length: a systematic review and meta-analysis protocol

et al. 2021

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Background Preterm birth (PTB) is estimated to affect 14.9 million babies globally every year. Global rates of PTB continue to increase from 9.8 to 10.6% over a 15-year period from 2000 to 2014. Vaginal progesterone is commonly used by clinicians as a prevention strategy, with recent evidence affirming the benefit of vaginal (micronised) progesterone to prevent PTB in women with a shortened cervix (< 25 mm). Given the low incidence of a short cervix at mid-gestation in high-risk populations further evidence is required. The objective of this review is to determine if vaginal progesterone reduces spontaneous preterm birth (sPTB) before 37 weeks in asymptomatic high-risk women with a singleton pregnancy with a normal mid-gestation cervical length. Methods Studies will be sourced from MEDLINE, Embase and Cochrane Register of Trials (CENTRAL) from their inception onwards with the search terms ‘progesterone’ and ‘preterm birth’. Studies will be screened and included if they assess vaginal progesterone compared to placebo in women with a normal cervical length. The primary outcome will be sPTB < 37 weeks, with secondary outcomes of sPTB < 34 weeks. Two independent reviewers will conduct study screening at abstract and full text level, data extraction and risk of bias assessment with disagreements resolved by an experienced researcher. The Mantel-Haenszel statistical method and random effects analysis model will be used to produce treatment effect odds ratios and corresponding 95% confidence intervals. Discussion This review will assess the current body of evidence and provide clarity regarding the potential benefits and best practice of use of vaginal progesterone in asymptomatic women with high-risk singleton pregnancies and normal cervical length. Trial registration PROSPERO CRD42020152051

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“…A number of interventions have been shown to signi cantly decrease the rate of spontaneous preterm birth (sPTB) including: specialist antenatal clinics for women at high risk of PTB(6); cervical cerclage for women with a previous sPTB and/or a short cervix (< 25 mm) (7,8) and vaginal progesterone for women with cervical length < 25 mm (11)(12)(13)(14)(15). Progesterone decreases uterine contractility through inhibition of production of prostaglandins in the myometrium (9) and has been shown to be important in maintaining a pregnancy until term (10).…”

Section: Introductionmentioning

confidence: 99%

“…This IPD suggested that vaginal progesterone is still bene cial even in nulliparous women with only a short cervix as a risk factor (8). As only 5.8-7.3% of high risk women (11,12), and 0.45-1.68% in unselected populations (13)(14)(15) have a short cervix at mid gestation, the number of women who bene t from progesterone is relatively low. It is currently unclear whether vaginal progesterone would be of bene t to the other highrisk women with a normal mid-gestation cervical length (> 25 mm).…”

Section: Introductionmentioning

confidence: 99%

Vaginal Progesterone for Prevention of Preterm Birth in Asymptomatic High-Risk Women with a Normal Cervical Length: A Systematic Review and Meta-Analysis Protocol

Williams

McAuliffe²,

Diacci³

et al. 2020

Preprint

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Background: Preterm birth (PTB) is estimated to affect 14.9 million babies globally every year. Global rates of PTB continue to increase from 9.8% to 10.6% over a 15-year period from 2000 to 2014. Vaginal progesterone is commonly used by clinicians as a prevention strategy, with recent evidence affirming the benefit of vaginal (micronized) progesterone to prevent PTB in women with a shortened cervix (<25mm). Given the low incidence of a short cervix at mid-gestation in high-risk populations further evidence is required. The objective of this review is to determine if vaginal progesterone reduces spontaneous preterm birth (sPTB) before 37 weeks in asymptomatic high-risk women with a singleton pregnancy with a normal mid-gestation cervical length. Methods: Studies will be sourced from MEDLINE and Embase databases with the search terms “progesterone” and “preterm birth”. Studies will be screened and included if they assess vaginal progesterone compared to placebo in women with a normal cervical length. The primary outcome will be sPTB <37 weeks, with secondary outcomes of sPTB <34 weeks. Two independent reviewers will conduct study screening at abstract and full text level, data extraction and risk of bias assessment with disagreements resolved by an experienced researcher. The Mantel-Haenszel statistical method and random effects analysis model will be used to produce treatment effect odds ratios and corresponding 95% confidence intervals.Discussion: This review will assess the current body of evidence and provide clarity regarding the potential benefits and best practice of use of vaginal progesterone in asymptomatic women with high risk singleton pregnancies and normal cervical length. Trial registration: This study has been registered on PROSPERO with the registration number CRD42020152051

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The prevalence of short cervix between 20 and 24 weeks of gestation and vaginal progesterone for prolonging of gestation

Cited by 13 publications

References 11 publications

Recent advances in the prevention of preterm birth

Recent advances in the prevention of preterm birth

Vaginal progesterone for prevention of preterm birth in asymptomatic high-risk women with a normal cervical length: a systematic review and meta-analysis protocol

Vaginal Progesterone for Prevention of Preterm Birth in Asymptomatic High-Risk Women with a Normal Cervical Length: A Systematic Review and Meta-Analysis Protocol

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