Role of oral micronized progesterone versus vaginal progesterone for prevention of preterm labour
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20171532Keywords:
NICU, Preterm birth, Preterm delivery, Progesterone, Vaginal progesteroneAbstract
Background: Preterm birth remains a significant problem in obstetric care, affecting women and babies world-wide. Progesterone has an essential role in maintaining pregnancy by suppression of the calcium–calmodulin–myosin light chain kinase system. This study reflects the use of progesterone in preventing preterm birth.
Methods: The data were collected as a retrospective study from SAMC and PGI Obstetric and Gynaecology Department.
Results: With the use of Oral micronized progesterone out of 15 cases, term delivery 9 cases i.e. 60% and preterm delivery 6 cases i.e 40% and, with the use of vaginal progesterone suppository out of 15 cases, term delivery 11 cases i.e.73.3%, preterm delivery only 4 cases i.e 26.7%.
Conclusions: Progesterone appears to be safe and efficacious in reducing the risk of preterm birth as well as NICU admissions, and neonatal morbidity and mortality in high risk patients. However, there is limited information available relating to longer-term infant and childhood outcomes, the assessment of which remains a priority. Further, trials are required to assess the optimal timing, mode of administration and dose of administration of progesterone therapy when given to women considered to be at increased risk of early birth.
References
Chatterjee J, Gullam J, Vatish M, Thornton S. The management of preterm labour. Arch Dis Child Fetal Neonatal Ed. 2007;92(2):F88-F93.
Nour NM. Premature Delivery and the Millennium Development Goal. Rev Obstet Gynecol. 2012;5(2):100-5.
Tucker JM, Goldenberg RL, Davis RO, Copper RL, Winkler CL, Hauth JC. Etiologies of preterm birth in an indigent population: Is prevention a logical expectation. Obstet Gynecol. 1991;77:343-7.
Peltier MR. Immunology of term and preterm labor. Reprod Biol Endocrinol. 2003;1:122.
European community collaborative study of outcome of pregnancy between 22 and 28 weeks gestation. Working group on the very low birthweight infant. Lancet. 1990;336:782–784
Chan K, Ohlsson A, Synnes A, Lee DSC, Chien L, Lee SK et al. Survival, morbidity, and resource use of infants of 25 weeks gestational age or less. Am J Obstet Gynecol. 2001;185:220-2.
Kramer MS, Demissie K, Yang H, Platt RW, Sauvé R, Liston RJAMA. The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. 2000;284(7):843-9.
Lefebvre F, Glorieux J, St-Laurent-Gagnon T. Neonatal survival and disability rate at age 18 months for infants born between 23 and 28 weeks of gestation. Am J Obstet Gynecol. 1996;174(3):833-8.
Elder DE, Hagan R, Evans SF, Benninger HR, French NPJ. Hospital admissions in the first year of life in very preterm infants. Paediatr Child Health. 1999;35(2):145-50.
Astle S, Slater DM, Thornton S. The involvement of progesterone in the onset of human labour. Eur J Obstet Gynecol Reprod Biol. 2003;108(2):177-81.
Dodd JM. The role of progesterone in prevention of preterm birth, Int J Womens Health. 2009;1:73-84.
da Fonseca EB, Bittar RE, Carvalho MH, Zugaib M. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study. AJOG;188(2):419-24.
Mackenzie R, Walker M, Armson A, Hannah ME. Progesterone for the prevention of preterm birth among women at increased risk: a systematic review and meta-analysis of randomized controlled trials. AJOG.2006;194:1234-42.
Su LL, Samuel M, Chong YS. Progestational agents for treating threatened or established preterm labour. Cochrane Database Syst Rev. 2014;(1):CD006770.
Dodd JM, Jones L, Flenady V, Cincotta R, Crowther CA. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane Database Syst Rev. 2013;(7):CD004947
Rai P, Rajaram S, Goel N, Ayalur Gopalakrishnan R, Agarwal R, Mehta S. Oral micronized progesterone for prevention of preterm birth. Int J Gynaecol Obstet. 2009;104(1):40-3.