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, Kimberley P.; McAuliffe, Liam; Diacci, Rosanna; Aubin, Anne‐Marie; Issah, Ashad; Wang, Carol; Phung, Jason; Pennell, Craig E.

doi:10.1186/s13643-021-01702-9

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…Em mulheres com gestação única e colo curto ao US, a via vaginal apresentou maior redução de partos <34 semanas quando comparado a outras vias 1,19,21,51,60 . Care et al 9 , em revisão sistemática e metanálise, observaram que a progesterona vaginal deve ser considerada como a melhor escolha para gestações únicas assintomáticas com risco de parto pré-termo devido a colo curto ou história de parto pré-termo espontâneo anterior 9 .…”

Section: Progesteronaunclassified

Desafios na prevenção do parto pré-termo associado à insuficiência cervical

Nunes,

Oliveira,

Silva

et al. 2024

J bras Ginec

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Introdução:A insuficiência cervical é um importante fator de risco de prematuridade, principal causa de morbidade e mortalidade perinatais. Objetivo: Revisar critérios diagnósticos e estratégias para reduzir partos pré-termos associados à insuficiência cervical. Métodos: Revisão bibliográfica dos últimos cinco anos (2018–2023), nas bases de dados Pubmed e Biblioteca Virtual em Saúde, usando descritores relacionados à insuficiência cervical. Foram consideradas revisões sistemáticas e metanálises, e guidelines. Resultados:Foram incluídos 69 artigos. A insuficiência cervical tem critérios diagnósticos pouco claros. As evidências atuais orientam que seu diagnóstico pode ser obtido através da história obstétrica sugestiva, da identificação de colo curto (≤25 mm) por meio de ultrassom, ou colo dilatado na ausência de trabalho de parto na gestação atual. Em mulheres com história sugestiva de insuficiência cervical, é indicada cerclagem eletiva. Em gestações únicas submetidas à vigilância por ultrassom do comprimento cervical entre 160/7 e 246/7 semanas, deve ser oferecida cerclagem para colo curto. Em gestação única, a progesterona está indicada na história de parto pré-termo espontâneo, ou quando observado colo curto no ultrassom transvaginal mesmo sem história de parto pré-termo anterior. Em pacientes de risco habitual, a medida de colo uterino é indicada entre 18 e 24 semanas de gestação, durante o ultrassom morfológico de segundo trimestre. Não há evidências suficientes que suportem o uso do pessário para prevenção de parto pré-termo. Em gestações gemelares não selecionadas, não há evidências para uso de progesterona ou cerclagem cervical para redução de parto pré-termo. Conclusão: A decisão sobre a melhor forma de minimizar o risco de perda gestacional associada à insuficiência cervical deve ser individualizada, considerando a história obstétrica, o encurtamento (ou dilatação) cervical, a experiência da equipe assistencial e o consentimento da gestante.

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Section: Progesteronaunclassified

Desafios na prevenção do parto pré-termo associado à insuficiência cervical

Nunes,

Oliveira,

Silva

et al. 2024

J bras Ginec

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“…The EPPPIC trial concluded that progesterone also works when the cervical length is between 25 and 30 mm, but the number of included women was small (57). There is also some unclarity whether women with a previous preterm birth and normal cervical length should be offered progesterone (57,128,129). The same applies to whether progesterone works for other risk factors of preterm birth, e.g., cervical conization (130) or for newly identified risk factors as a history of a second stage caesarean delivery (131,132).…”

Section: Research Implicationsmentioning

confidence: 99%

Progesterone, cerclage, pessary, or acetylsalicylic acid for prevention of preterm birth in singleton and multifetal pregnancies – A systematic review and meta-analyses

Wennerholm

Bergman²,

Kuusela³

et al. 2023

Front. Med.

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BackgroundPreterm birth is the leading cause of childhood mortality and morbidity. We aimed to provide a comprehensive systematic review on randomized controlled trials (RCTs) on progesterone, cerclage, pessary, and acetylsalicylic acid (ASA) to prevent preterm birth in asymptomatic women with singleton pregnancies defined as risk of preterm birth and multifetal pregnancies.MethodsSix databases (including PubMed, Embase, Medline, the Cochrane Library) were searched up to February 2022. RCTs published in English or Scandinavian languages were included through a consensus process. Abstracts and duplicates were excluded. The trials were critically appraised by pairs of reviewers. The Cochrane risk-of-bias tool was used for risk of bias assessment. Predefined outcomes including preterm birth, perinatal/neonatal/maternal mortality and morbidity, were pooled in meta-analyses using RevMan 5.4, stratified for high and low risk of bias trials. The certainty of evidence was assessed using the GRADE approach. The systematic review followed the PRISMA guideline.ResultsThe search identified 2,309 articles, of which 87 were included in the assessment: 71 original RCTs and 16 secondary publications with 23,886 women and 32,893 offspring. Conclusions were based solely on trials with low risk of bias (n = 50).Singleton pregnancies: Progesterone compared with placebo, reduced the risk of preterm birth <37 gestational weeks: 26.8% vs. 30.2% (Risk Ratio [RR] 0.82 [95% Confidence Interval [CI] 0.71 to 0.95]) (high certainty of evidence, 14 trials) thereby reducing neonatal mortality and respiratory distress syndrome. Cerclage probably reduced the risk of preterm birth <37 gestational weeks: 29.0% vs. 37.6% (RR 0.78 [95% CI 0.69 to 0.88]) (moderate certainty of evidence, four open trials). In addition, perinatal mortality may be reduced by cerclage. Pessary did not demonstrate any overall effect. ASA did not affect any outcome, but evidence was based on one underpowered study.Multifetal pregnancies: The effect of progesterone, cerclage, or pessary was minimal, if any. No study supported improved long-term outcome of the children.ConclusionProgesterone and probably also cerclage have a protective effect against preterm birth in asymptomatic women with a singleton pregnancy at risk of preterm birth. Further trials of ASA are needed. Prevention of preterm birth requires screening programs to identify women at risk of preterm birth.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021234946].

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Prevention of Preterm Birth by Cervical Pessary Combined with Vaginal Progesterone: a Systematic Review and Meta-analysis with Trial Sequential Analysis

Zhuang

et al. 2022

Reprod. Sci.

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This study was to assess the effectiveness of cervical pessary combined with vaginal progesterone for the prevention of preterm birth (PTB). Ten studies about singleton [five randomized controlled trials (RCTs), vs vaginal progesterone; four cohorts, vs vaginal progesterone; two cohorts, vs cervical cerclage + vaginal progesterone] and two cohort studies about multiple pregnancies (vs vaginal progesterone) were included after searching electronic databases. For singleton pregnancies, the meta-analysis of three non-RCTs [relative risk (RR) = 0.41, p = 0.001] or total trials in non-Asian country (RR = 0.56, p = 0.03) revealed that compared with vaginal progesterone alone, cervical pessary + vaginal progesterone treatment had significant effectiveness on preventing PTB < 34 weeks, but not for five RCTs; meta-analysis of two trials showed that cervical pessary + vaginal progesterone had no significant prevention effects of PTB compared with cervical cerclage + vaginal progesterone. For multiple pregnancies, meta-analysis of two trials showed that compared with vaginal progesterone, cervical pessary + vaginal progesterone treatment increased neonatal birth weight (standardized mean difference = 0.50, p = 0.01). Trial sequential analysis implied additional studies were required. Four studies vs other controls (pessary, three-combined, tocolysis, conservative or no treatment; one study, each) were selected for systematic review. In conclusion, cervical pessary combined with vaginal progesterone may be safe and effective to prevent PTB in singleton pregnancies and increase neonatal birth weight in the multiple pregnancies compared with vaginal progesterone alone.

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

Cited by 3 publications

References 25 publications

Desafios na prevenção do parto pré-termo associado à insuficiência cervical

Desafios na prevenção do parto pré-termo associado à insuficiência cervical

Progesterone, cerclage, pessary, or acetylsalicylic acid for prevention of preterm birth in singleton and multifetal pregnancies – A systematic review and meta-analyses

Prevention of Preterm Birth by Cervical Pessary Combined with Vaginal Progesterone: a Systematic Review and Meta-analysis with Trial Sequential Analysis

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