Vaginal progesterone, oral progesterone, 17‐OHPC, cerclage, and pessary for preventing preterm birth in at‐risk singleton pregnancies: an updated systematic review and network meta‐analysis

Abstract

Background Recent progesterone trials call for an update of previous syntheses of interventions to prevent preterm birth.Objectives To compare the relative effects of different types and routes of administration of progesterone, cerclage, and pessary at preventing preterm birth in at-risk women overall and in specific populations.Search strategy We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL, and Web of Science up to 1 January 2018.Selection criteria We included randomised trials of progesterone, cerclage or pessary for preventing preterm birth in at-risk singleton pregnancies.Data collection and analysis We used a piloted data extraction form and performed Bayesian random-effects network metaanalyses with 95% credibility intervals (CrI), as well as pairwise meta-analyses, rating the quality of the evidence using GRADE.Main results We included 40 trials (11 311 women). In at-risk women overall, vaginal progesterone reduced preterm birth <34 (OR 0.43, 95% CrI 0.20-0.81) and <37 weeks (OR 0.51, 95% CrI 0.34-0.74), and neonatal death (OR 0.41, 95% CrI 0.20-0.83). In women with a previous preterm birth, vaginal progesterone reduced preterm birth <34 (OR 0.29, 95% CI 0.12-0.68) and <37 weeks (OR 0.43, 95% CrI 0.23-0.74), and 17ahydroxyprogesterone caproate reduced preterm birth <37 weeks (OR 0.53, 95% CrI 0.27-0.95) and neonatal death (OR 0.39, 95% CI 0.16-0.95). In women with a short cervix (≤25 mm), vaginal progesterone reduced preterm birth <34 weeks (OR 0.45, 95% CI 0.24-0.84). ConclusionsVaginal progesterone was the only intervention with consistent effectiveness for preventing preterm birth in singleton atrisk pregnancies overall and in those with a previous preterm birth.

Cervical pessary plus vaginal progesterone versus long‐term tocolysis for the prevention of preterm birth: An observational retrospective study

“…Vaginal progesterone prevents preterm birth through an anti‐inflammatory effect by neutralizing the initial inflammation that triggers the development of preterm labor or the rupturing of membranes. Introducing progesterone transvaginally seems to be most effective, and has been coupled with a pessary in a previous study …”

History-indicated transvaginal cerclage: results from a single-centre

“…More recent systematic reviews and meta-analysis have compared progesterone, cerclage and pessary in decreasing preterm birth, with controversial results: one concluding that vaginal progesterone was the only intervention with consistent effectiveness for preventing preterm birth in singleton atrisk pregnancies whereas another defends that cervical cerclage showed clear benefit for women with singleton pregnancy and high risk of PTB. 10,11 These alternatives were not considered for our patients as progesterone use in this context is a very recent recommendation and pessary is not available in our country.…”

From structural modalities in perinatal medicine to the frequency of preterm birth

“…According to the WHO definition, a child is born preterm if it is born before the completed 37th week of gestation or with fewer than 259 days since the first day of the mother's last menstrual period. Depending on completed gestational age in weeks, preterm neonates are divided into extremely preterm (< 28), very preterm (28)(29)(30)(31), and moderately preterm born neonates (≥ 32). From the 34th week of gestation onwards, these children are also referred to as late preterm neonates [2].…”