Vaginal Progesterone Cuts Preterm Birth, Neonatal Deaths

Reduces preterm birth, neonatal morbidity and mortality in asymptomatic women with short cervix

FRIDAY, Dec. 16 (HealthDay News) -- For asymptomatic women with a sonographically identified short cervix in the mid-trimester, treatment with vaginal progesterone reduces the risk of preterm birth and neonatal morbidity and mortality, according to a meta-analysis published online Dec. 12 in the American Journal of Obstetrics & Gynecology.

Roberto Romero, M.D., from the National Institute of Child Health and Human Development in Bethesda, Md., and colleagues reviewed available literature to investigate the effect of treatment with vaginal progesterone in the mid-trimester, for asymptomatic women with a short cervix identified on sonogram (≤25 mm). Individual patient data from five randomized controlled trials, including 775 women and 827 infants, were meta-analyzed. The outcomes measured included preterm birth, and neonatal morbidity and mortality.

The investigators found that women treated with vaginal progesterone had significant reductions in preterm births at less than 28, 33, and 35 weeks (risk rates [RR], 0.50, 0.58, and 0.69, respectively). In addition, treatment was associated with a significant decrease in respiratory distress syndrome (RR, 0.48), composite neonatal morbidity and mortality (RR, 0.57), birth weight of less than 1,500 grams (RR, 0.55), admission to the neonatal intensive care unit (RR, 0.75), and the need for mechanical ventilation (RR, 0.66). The rate of adverse maternal events or congenital anomalies did not differ significantly between the vaginal progesterone and placebo groups.

"Vaginal progesterone administration to asymptomatic women with a sonographic short cervix reduces the risk of preterm birth and neonatal morbidity and mortality," the authors write.

Several authors disclosed financial ties to companies involved in marketing vaginal progesterone gel for the prevention of preterm birth, including Columbia Laboratories, Inc. and Watson Pharmaceuticals.

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