Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth

Cochrane Review by Dodd JM, Flenady V, Cincotta R, Crowther CA

This record should be cited as: Dodd JM, FlenadyV,CincottaR,CrowtherCA. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004947. DOI: 10.1002/14651858.CD004947.pub2.

ABSTRACT

Title

Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth

Background

Preterm birth is a major complication of pregnancy associated with perinatal mortality and morbidity. Progesterone for the prevention of preterm labour has been advocated.

Objectives

To assess the benefits and harms of progesterone for the prevention of preterm birth for women considered to be at increased risk of preterm birth.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (December 2008) and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1).

Selection criteria

Randomised controlled trials, in which progesterone was given for preventing preterm birth.

Data collection and analysis

Two authors independently evaluated trials for methodological quality and extracted data.

Main results

Eleven randomised controlled trials (2714 women and 3452 infants) were included. Progesterone versus placebo for women with a past history of spontaneous preterm birth: Progesterone was associated with a statistically significant reduction in the risk of pretermbirth less than 34 weeks’ gestation (one study; 142 women; risk ratio (RR) 0.15; 95% confidence interval (CI) 0.04 to 0.64); preterm birth less than 37 weeks’ gestation (four studies; 1255 women; RR 0.80; 95% CI 0.70 to 0.92); infant birthweight less than 2500 grams (two studies; 501 infants; RR 0.64; 95% CI 0.49 to 0.83). Progesterone versus placebo for women with a short cervix identified on ultrasound: Progesterone was associated with a statistically significant reduction in the risk of preterm birth less than 34 weeks (one study; 250 women; RR 0.58; 95% CI 0.38 to 0.87); and neonatal sepsis (one study; 274 infants; RR 0.28; 95% CI 0.08 to 0.97). Progesterone versus placebo for women with a multiple pregnancy: Progesterone was associated with a statistically significant reduction in the risk of antenatal tocolysis (one study; 654 women; RR 0.75; 95% CI 0.57 to 0.97). Progesterone versus placebo for women following presentation with threatened preterm labour: Progesterone, was associated with a statistically significant reduction in the risk of preterm birth less than 37 weeks (one study; 60 women; RR 0.29; 95% CI 0.12 to 0.69), infant birthweight less than 2500 grams (one study; 70 infants; RR 0.52; 95% CI 0.28 to 0.98); and respiratory distress syndrome (one study; 70 infants; RR 0.30; 95% CI 0.11 to 0.83). Progesterone versus placebo for women with ’other’ risk factors for preterm birth: Progesterone was associated with no statistically significant differences for the reported outcomes.

Authors' conclusions

Further trials are required to assess the benefits and harms of progesterone therapy when given to women considered to be at increased risk of early birth.

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