• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Does Vaginal Progesterone Improve Birth Outcomes for Mothers with Short Cervix?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Efficacy of vaginal progesterone to prevent preterm birth and adverse perinatal outcomes in women with short cervix has been questioned in recent literature
  • Romero et al. (AJOG, 2018) examined whether vaginal progesterone prevents preterm birth and improves perinatal outcomes in asymptomatic women with a singleton gestation and a short cervix ≤25mm

METHODS:

  • Systematic Review and meta-analysis
  • Literature search of eligible randomized controlled trials (RCTs) comparing vaginal progesterone with placebo/no treatment in women with a singleton gestation and a midtrimester sonographic cervical length ≤25 mm
  • Primary outcome: Preterm birth <33 weeks of gestation
  • Secondary outcomes: Preterm birth <37, <36, <35,
  • <34, <32, <30 and <28 weeks of gestation and other adverse perinatal outcomes and neurodevelopmental and health outcomes at 2 years of age

RESULTS:

  • Data was pooled from 974 women with a cervical length ≤25 mm participating in five high-quality trials
  • Vaginal progesterone was linked to a significantly reduced risk of preterm birth <33 weeks of gestation (relative risk [RR] 0.62, 95% CI 0.47-0.81, P=0.0006; high-quality evidence)
  • Vaginal progesterone significantly decreased the risk of preterm birth <36, <35, <34, <32, <30 and <28 weeks of gestation, spontaneous preterm birth <33 and <34 weeks of gestation, respiratory distress syndrome, composite neonatal morbidity and mortality, birthweight <1500 and <2500 g, and admission to the neonatal intensive care unit (RRs from 0.47 to 0.82; high-quality evidence for all)
  • There were seven (1.4%) neonatal deaths in the vaginal progesterone group and 15 (3.2%) in the placebo group (RR 0.44, 95% CI 0.18-1.07, P=0.07; low-quality evidence)
  • Maternal adverse events, congenital anomalies, and adverse neurodevelopmental and health outcomes at 2 years of age did not differ between groups

CONCLUSION:

  • Vaginal progesterone is safe, can decrease preterm birth risk and improve perinatal outcomes in women with short cervix regardless of previous history of preterm birth
  • Vaginal progesterone, in this study, was associated with a 41% reduction in the frequency of a composite outcome of neonatal death combined with common neonatal complications seen in preterm newborns
  • The authors calculate that a universal transvaginal cervical length screening program and treatment with vaginal progesterone for those with a cervical length ≤25 mm would prevent 31,800 preterm births <34 weeks of gestation and 19,800 cases of major neonatal morbidity or mortality

Learn More – Primary Sources:

Vaginal Progesterone for Preventing Preterm Birth and Adverse Perinatal Outcomes in Singleton Gestations with a Short Cervix: A Meta-Analysis of Individual Patient Data

image_pdfFavoriteLoadingFavorite

< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

SMFM Statement: Choice of Progestogen for Preterm Birth Prevention
Vaginal Progesterone to Prevent Preterm Birth in Twins
Do Progestogens Prevent Preterm Birth in Symptomatic Pregnancies with a Short Cervix?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Download Your ObG App
HERE!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

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.

Disclaimer

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

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site