Do Progestogens Prevent Preterm Birth in Symptomatic Pregnancies with a Short Cervix?
BACKGROUND AND PURPOSE:
Vaginal progesterone reduces risk of preterm birth in asymptomatic women with short cervix
Studies in symptomatic women and short cervix are inconclusive
Facchinetti et al. (Obstetrics & Gynecology) analyzed the efficacy of progestogens as a tocolytic agent in women with a short cervix
Randomized Controlled Trial (RCT)
Singleton pregnancies between 22 weeks 0 days and 31 weeks and 6 days gestation
Arrested preterm labor with a cervix ≤ 25 mm
Previous preterm birth excluded
Participants received one of the following:
Vaginal micronized progesterone (200 mg per day)
Intramuscular 17[alpha]-hydroxyprogesterone caproate (17-OHPC) (341 mg per week)
No treatment (control group)
Proportion of women with preterm birth < 37 week of gestation
254 women randomized and 235 women remained for analysis
Preterm birth rate did not differ significantly between groups:
23% in the 17-OHPC
39% in the vaginal progesterone group
22% in the control group
Trial stopped during interim analysis (after 50% enrollment) due to futility (nonstatistical increase in preterm birth in vaginal progesterone group and difference even if study continued unlikely to show difference)
Data in this study contradict previous study by this team
Possible explanations include weekly rather than 2x/week
More stringent study criteria in this study
Exclusion of prior preterm birth and 17-OHPC known to prevent subsequent preterm birth
Rigorous and not subjective diagnosis of short cervix
Possible that 17-OHPC could still be useful in very high risk (cervix < 15 mm)
Progestogen use in symptomatic women with a short cervix does not reduce risk for preterm birth once the cervix is ≤ 25 mm
Please log in to access ObGFirst and the 2T US Atlas
Media - Internet
Computer System Requirements
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan