Vaginal Progesterone in Asymptomatic Women with Short Cervical Length on Ultrasound: is it Beneficial?

Abstract

The aim of the present study was to determine the efficacy of vaginal progesterone in asymptomatic women with a sonographic short cervix (B25 mm) at 18-24 weeks of gestation in reducing the risk of preterm birth. It was a prospective observational study carried out on 60 pregnant women attending the antenatal clinic in tertiary health institute between 18 and 24 weeks of gestation with ultrasonographically-measured short cervix. The women with cervical length B25 mm were alternately divided into two groups of 30 each. Group I was given 200 mg vaginal micronized progesterone capsules and Group II was managed expectantly. Primary outcome was measured as spontaneous birth before 34 weeks of gestation. Secondary outcome was birth at \32 weeks, \37 weeks and the neonatal outcome. The demographic profile of women in both the groups was similar. The rate of spontaneous delivery before 34 and 37 weeks of gestation was significantly less in the progesterone group (3 vs 20 %; p = 0.044, 6.6 vs 26.7 %; p = 0.038). There was no difference in birth weight \2500 g and Apgar score \7 at 5 min in neonates of both the groups. Progesterone was associated with a significant reduction in composite neonatal morbidity (6.7 vs 33.3 %; p = 0.020). There were no serious adverse events associated with the use of progesterone. Thus, in a woman with short cervical length, vaginal progesterone significantly lowers the preterm birth rate and composite neonatal morbidity.

Vaginal progesterone in risk reduction of preterm birth in women with short cervix

“…Results in the birth weight of less than 2.5 kg have been found to be statistically significant in the present study (p = 0.033). Similar results were seen in study by Romero et al 15 However non significant results were seen in other studies done by Fonseca et al, Hassan et al, and Anjali et al [12][13][14] In terms of neonatal sepsis and requirement of ventilator the results have been found to be statistically significant in present study similar to the study by Fonseca et al with their results also found to be statistically significant. 6 In terms of admission to NICU, similar results were seen in other two studies mentioned by Fonseca et al, and Romero et al, with their results also found to be statistically significant (p = 0.05 and p = 0.003 respectively).…”

“…Similar results were seen in two other studies by Anjali et al, and Romero et al, with their results also found to be statistically significant (p = 0.044 and p = 0.003 respectively). 14,15 At gestational age between 33 to <35 weeks of gestation this comparison has been found to be statistically significant (p = 0.045) in the present study. Similar results were seen in other studies by Fonseca et al, Hassan et al, Anjali et al, and Romero et al, with their results also found to be statistically significant (p = 0.007, p = 0.016, p = 0.044 and p = 0.003 respectively).…”

“…Similar results were seen in other studies by Fonseca et al, Hassan et al, Anjali et al, and Romero et al, with their results also found to be statistically significant (p = 0.007, p = 0.016, p = 0.044 and p = 0.003 respectively). [12][13][14][15] Results in the birth weight of less than 1.5 kg have been found to be statistically significant in the present study (p value = 0.036). Similar results were seen in other two studies by Hassan et al, and Romero et al, with their results also found to be statistically significant (p = 0.01 and p = 0.004 respectively).…”

“…6 In terms of admission to NICU, similar results were seen in other two studies mentioned by Fonseca et al, and Romero et al, with their results also found to be statistically significant (p = 0.05 and p = 0.003 respectively). 12,15 However non significant results were seen in study done by Anjali et al 14 There was no statistical significance in both the groups in terms of maternal adverse events like vaginal discharge, vaginal pruritus and other side effects. Similar result was seen in the study done by Romero et al, where 11% women in Control Group and 12% women in the Progesterone Group had maternal adverse events which was comparable to our results.…”