Progesterone supplementation for prevention of preterm labor: A randomized controlled trial

Ibrahim, Moustafa I.; Ramy, Ahmed; Younis, Moustafa Abdel-Fattah

doi:10.1016/j.mefs.2010.03.007

Cited by 32 publications

(43 citation statements)

References 7 publications

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“…A control group of usual care or placebo was compared with progesterone (either type) in 17 studies, [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] with cerclage in 12 studies [44][45][46][47][48][49][50][51][52][53][54][55] and with pessary in three studies. [56][57][58] In addition, one study compared 17-OHPC with cerclage 59 and three studies compared natural progesterone with 17-OHPC [60][61][62] (Table 1, and see Supporting information, Figure S2).…”

Section: Study Characteristicsmentioning

confidence: 99%

Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta‐analysis

Jarde

Lutsiv

Park

et al. 2017

BJOG

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Background Preterm birth (PTB) is the leading cause of infant death, but it is unclear which intervention is best to prevent it.Objectives To compare progesterone, cerclage and pessary, determine their relative effects and rank them.Search strategy We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL and Web of Science (to April 2016), without restrictions, and screened references of previous reviews.Selection criteria We included randomised trials of progesterone, cerclage or pessary for preventing PTB in women with singleton pregnancies at risk as defined by each study.Data collection and analysis We extracted data by duplicate using a piloted form and performed Bayesian random-effects network meta-analyses and pairwise meta-analyses. We rated evidence quality using GRADE, ranked interventions using SUCRA and calculated numbers needed to treat (NNT).Main results We included 36 trials (9425 women; 25 low risk of bias trials). Progesterone ranked first or second for most outcomes, reducing PTB < 34 weeks [odds ratio (OR) 0.44; 95% credible interval (CrI) 0.22-0.79; NNT 9; low quality], <37 weeks (OR 0.58; 95% CrI 0.41-0.79; NNT 9; moderate quality), and neonatal death (OR 0.50; 95% CrI 0.28-0.85; NNT 35; high quality), compared with control, in women overall at risk. We found similar results in the subgroup with previous PTB, but only a reduction of PTB < 34 weeks in women with a short cervix. Pessary showed inconsistent benefit and cerclage did not reduce PTB < 37 or <34 weeks.Conclusions Progesterone was the best intervention for preventing PTB in singleton pregnancies at risk, reducing PTB < 34 weeks, <37 weeks, neonatal demise and other sequelae.Keywords Cervical cerclage, cervical pessary, network metaanalysis, preterm birth, progesterone, systematic review.Tweetable abstract Progesterone was better than cerclage and pessary to prevent preterm birth, neonatal death and more in network meta-analysis.Please cite this paper as: Jarde A, Lutsiv O, Park CK, Beyene J, Dodd JM, Barrett J, Shah PS, Cook JL, Saito S, Biringer AB, Sabatino L, Giglia L, Han Z, Staub K, Mundle W, Chamberlain J, McDonald SD. Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta-analysis.

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Section: Study Characteristicsmentioning

confidence: 99%

Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta‐analysis

Jarde

Lutsiv

Park

et al. 2017

BJOG

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“…Two trials reported neonatal death outcomes. One found progestogen significantly decreased the risk of neonatal death compared with placebo (4% compared with 16%, PϽ.05), 29 whereas the other did not find a difference with progestogen treatment. 28 The Bayesian meta-estimate for neonatal death combining these two trials is a RR of 0.26 (95% Bayesian credible interval 0.00 -0.89; Fig.…”

Section: Resultsmentioning

confidence: 95%

“…20,24,25,28,29 Two found a significantly lower absolute risk with a 32% and a 41% decrease (54% compared with 22% and 57% compared with 16%, respectively) in preterm birth at less than 37 weeks of gestation with intramuscular 17␣-hydroxyprogesterone caproate compared with no treatment. 20,25 These two studies report outcomes for a combined total of 105 participants; however, there are 20 participants who were in both studies; thus, the results are only for 85 unique individuals.…”

Section: Resultsmentioning

confidence: 99%

“…2). 20,24,25,28,29 Outcomes for mean gestational age at birth and preterm birth at less than 35 weeks of gestation were only reported by one trial or had inconsistent findings. No trial reported preterm birth outcomes at 32 weeks of gestation or less or 28 weeks of gestation or less.…”

Section: Resultsmentioning

confidence: 99%

“…3). 28,29 Four studies reported mean birth weight. Three studies found a higher mean birth weight (245-492 g) among neonates whose mothers received progestogens compared with placebo, [23][24][25] and this was statistically significant in one study.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Progestogens for Preterm Birth Prevention

Likis

Edwards

Andrews

et al. 2012

Obstetrics & Gynecology

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Progestogens prevent preterm birth when used in singleton pregnancies for women with a prior preterm birth. In contrast, evidence suggests lack of effectiveness for multiple gestations. Evidence supporting all other uses is insufficient to guide clinical care. Overall, clinicians and patients lack longer-term information to understand whether intervention has the ultimately desired outcome of preventing morbidity and promoting normal childhood development.

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Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth

Flenady

Cincotta

et al. 2006

Cochrane Database of Systematic Reviews

134

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Progesterone supplementation for prevention of preterm labor: A randomized controlled trial

Cited by 32 publications

References 7 publications

Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta‐analysis

Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta‐analysis

Progestogens for Preterm Birth Prevention

Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth

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