Vaginal Progesterone to Prevent Preterm Birth in Twins
This study by Romero et al. (Ultrasound in Obstetrics and Gynecology, 2017) sought to determine if vaginal progesterone could prevent the preterm birth and newborn morbidity and mortality in an otherwise asymptomatic twin gestation with a mid-trimester sonographic short cervix (≤ 25mm).
Systematic Review and Meta-Analysis
303 women were included from 6 RCTs with 159 given vaginal progesterone. Vaginal progesterone significantly decreased the risk of preterm birth at < 33 weeks by approximately a third (31%). There was no difference in preterm birth at <37, <36 and <28 weeks. Neonatal death, composite neonatal morbidity and mortality, respiratory distress syndrome, use of mechanical ventilation, and low birth weight were also reduced. The authors downgraded the quality of these findings from high to moderate quality due to potential biases. In addition, dosing and route of medication delivery were not all the same in the various studies. Therefore, the authors acknowledge that future studies may challenge these findings. Of note, no neurodevelopmental differences were seen at ages 4-5 years between the two groups. Nor were there any differences in maternal adverse events demonstrated in this study.
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