Progesterone and nifedipine for maintenance tocolysis after arrested preterm labor: A systematic review and meta-analysis of randomized controlled trial

Ding, Mei; Luo, Xin; Zhang, Xuemei; Bai, Bing; Sun, Ju-Xiang; Qi, Hongbo

doi:10.1016/j.tjog.2015.07.005

Cited by 13 publications

(16 citation statements)

References 19 publications

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“…Two other meta-analyses from 2016 35 , 36 which included 4 and 5 RCTs also yielded contradictory statements. While Eke et al 35 included RCTs with oral/vaginal progesterone and 17-OHPC in their analysis and found no significant reduction in the rate of preterm birth < 37/<34 weeks of gestation, Ding et al 36 evaluated only RCTs with oral/vaginal progesterone as maintenance treatment. In comparison to oral nifedipine, a significant prolongation of pregnancy and a significant decrease in the rate of preterm birth < 37 weeks of gestation were able to be achieved with progesterone.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis by Ding et al 36 investigated 10 RCTs, 5 of which had oral nifedipine and 5 had oral/vaginal progesterone in comparison to placebo/no treatment for maintenance tocolysis between the 24th–34th week of gestation in the period from 1980 – 2014 13 , 28 , 30 , 37 , 38 . Not included were studies with intramuscular 17-OHPC; the progesterone dosages were 200 and 400 mg/day, primary tocolysis was performed with nifedipine, magnesium sulphate, ritodrine or atosiban.…”

Section: Maintenance Tocolysis/treatmentmentioning

confidence: 99%

“…In einer Metaanalyse von Ding et al 36 wurden 10 RCT, davon 5 mit oralem Nifedipin und 5 mit oralem/vaginalem Progesteron im Vergleich zu Placebo/keine Therapie zur Langzeittokolyse zwischen der 24. – 34.…”

Section: Erhaltungstokolyse/-therapieunclassified

“…Zwei weitere Metaanalysen aus dem Jahr 2016 35 , 36 , die 4 bzw. 5 RCT einschlossen, kamen ebenfalls zu widersprüchlichen Aussagen.…”

Section: Diskussionunclassified

“…5 RCT einschlossen, kamen ebenfalls zu widersprüchlichen Aussagen. Während Eke et al 35 RCT mit oralem/vaginalem Progesteron und 17-OHPC in ihre Analyse einschlossen und keine signifikante Senkung der Frühgeburtenrate < 37/<34 SSW fanden, evaluierten Ding et al 36 nur RCT mit oralem/vaginalem Progesteron zur Erhaltungstherapie. Im Vergleich zu oralem Nifedipin konnte mit Progesteron eine signifikante Verlängerung der Schwangerschaft und eine signifikante Verminderung der Frühgeburtenrate < 37 SSW erreicht werden.…”

Section: Diskussionunclassified

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Progesterone – Effective for Tocolysis and Maintenance Treatment After Arrested Preterm Labour?

Rath

Kuon

2019

Geburtshilfe Frauenheilkd

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Numerous experimental studies indicate that natural progesterone, through various mechanisms, exerts an inhibitory effect on uterine contractility and sensitises the myometrium for tocolytics. It was therefore appropriate to investigate the possible benefits of oral/vaginal progesterone and the synthetic progesterone derivative 17-α-hydroxyprogesterone caproate, applied intramuscularly, in clinical studies on primary tocolysis, additively to established tocolytics (“adjunctive tocolysis”) and as maintenance treatment after successful tocolysis in cases of threatened preterm birth. Three studies with a small number of cases do not yield any sufficient evidence for recommending progesterone/17-α-hydroxyprogesterone caproate as primary tocolysis in women with preterm labour. There is also no evidence that progesterone or 17-α-hydroxyprogesterone caproate combined with commonly used tocolytics leads to a prolongation of pregnancy and a significant decrease in the rate of preterm birth. The data on the use of progesterone as maintenance treatment is controversial. While randomised, controlled studies with low quality showed promising results, studies with high quality did not reveal any significant differences with regard to the rate of preterm birth < 37 weeks of gestation, the latency period until delivery and in the neonatal outcome between progesterone/17-α-hydroxyprogesterone caproate and placebo or no treatment. Significant differences in the methodology, the inclusion and outcome criteria, the mode of application and the dosages of the substances as well as the inadequate statistical power as a result of low numbers of cases make interpretation and comparability of the studies difficult. Therefore, well-designed randomised, placebo-controlled, double-blind studies with uniform primary outcome criteria are needed in order to clarify whether progesterone and via which route of administration and at which dosage is of clinical benefit for patients with manifest preterm contractions and as maintenance treatment after arrested preterm labour.

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