Does Vaginal Progesterone Prevent Recurrent Preterm Birth When Cervical Length is >25 mm?
BACKGROUND AND PURPOSE:
Data is limited regarding the benefit of vaginal progesterone for women with a history of spontaneous preterm birth and a cervix >25 mm
Conde-Agudelo et al. (AJOG, 2022) assessed the efficacy of vaginal progesterone in preventing preterm birth in this subset of patients
Post-hoc subgroup analysis of previously published meta-analysis
Inclusion criteria for original meta-analysis
Studies that compared vaginal progesterone vs placebo or no treatment for recurrent preterm birth prevention
Subgroup analysis exposure
Short cervix ≤25 mm
Cervical length >25 mm
Pooled relative risk was calculated by using a random-effects model
GRADE criteria were used to assess the quality of evidence
Preterm birth <37 and <34 weeks
Maternal and neonatal outcomes
10 trials in original meta-analysis
Cervical length >25 mm: There was no difference in the frequency of preterm birth <37 weeks between control and progesterone
RR 0.99 (95% CI, 0.84 to 1.16); P=0.88
Cervical length ≤25 mm (‘short cervix’): Vaginal progesterone significantly reduced the risk of preterm birth <37 weeks vs control
RR 0.72 (95% CI, 0.58 to 0.90)
Similar results were found for preterm birth <34 weeks and <28 weeks
There were no significant differences in the risk of adverse maternal or neonatal outcomes between progesterone and controls
There is no evidence that vaginal progesterone prevents preterm birth among women with a singleton gestation, a history of spontaneous preterm birth, and a cervical length >25 mm
The authors state
In summary, our findings reaffirm that vaginal progesterone should be offered to patients with a singleton gestation and a history of spontaneous preterm birth only if they have a midtrimester (18-24 weeks of gestation) transvaginal sonographic cervical length ≤25 mm
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