The role of micronized progesterone in preterm labour

Abstract

Objective: To study the role of intravaginal micronized progesterone in preterm labour in prolonging the pregnancy up to term and thus improving neonatal outcome Materials and Methods: A prospective randomized study wherein 100 pregnant women between 26-34 weeks of pregnancy admitted to labour ward with s/s of preterm labour were included in the study. After initial management with tocolytics and antenatal steroids, when the labour got arrested these women were randomly divided into two groups 1and 2. Group 1 received 200 ug of intravaginal micronized progesterone from inclusion in the study to 36 weeks or till delivery whichever was earlier.Group 2 received only supportive therapy. None of women received oral tocolytics after initial arrest of labour. All women were followed up till delivery and obstetric outcome noted Primary variables were prolongation of pregnancy from inclusion in study to delivery interval, gestation age at delivery. Neonatal outcome variables were birth weight, need for NICU transfer, length of stay in NICU and neonatal complications The results observed were subjected to statistical analysis by SPSS-13 unpaired student t-test, Mann-Whitney for quantitative variables and Chi-square/fisher exact for qualitative variables Results: The two groups were comparable in term of age, parity and rural/urban status. Baseline presentation characteristics of the two groups such as period of gestation, number of uterine contractions per 10 minutes, cervical dilatation and, cervical effacement were also comparable (p value <0.05). Mean gestational age at delivery in group 1 was significantly more than group 2 (36.808 weeks vs. 34.078 weeks). Patient delivering beyond 37 weeks of gestation were significantly more in group 1 (60%vs 14%). Prolongation of pregnancy was significantly more in group 1, mean no. of days being 34±15.25 and 24.22±12.73 in group 1 & 2 respectively. Neonatal outcome in terms of birth weight was significantly better in group 1.mean birth weight being 2675.2±382.20 and 2393.2±378.05 in group1 and 2 respectively. Neonatal complications in terms of need for NICU admission, RDS, sepsis and mechanical ventilation were more in group 2. Conclusion: In preterm labour once the labour is arrested with tocolytics, intravaginal micronized progesterone therapy is effective in prolonging the pregnancy and thus increasing the gestational age at delivery. Neonatal outcome is improved because of increased birth weight and lesser complications.