Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity : a systematic review and metaanalysis of individual patient data
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Date
Authors
Romero, Roberto
Nicolaides, Kypros
Conde-Agudelo, Agustin
Tabor, Ann
O’Brien, John M.
Cetingoz, Elcin
Da Fonseca, Eduardo
Creasy, George W.
Klein, Katharina
Rode, Line
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
OBJECTIVE : To determine whether the use of vaginal progesterone in asymptomatic women with a sonographic short cervix (≤ 25 mm) in the midtrimester reduces the risk of preterm birth and improves neonatal morbidity and mortality. STUDY DESIGN : Individual patient data metaanalysis of randomized controlled trials. RESULTS : Five trials of high quality were included with a total of 775 women and 827 infants. Treatment with vaginal progesterone was associated with a significant reduction in the rate of preterm birth <33 weeks (relative risk [RR], 0.58; 95% confidence interval [CI], 0.42-0.80), <35 weeks (RR, 0.69; 95% CI, 0.55-0.88), and <28 weeks (RR, 0.50; 95% CI, 0.30-0.81); respiratory distress syndrome (RR, 0.48; 95% CI, 0.30-0.76); composite neonatal morbidity and mortality (RR, 0.57; 95% CI, 0.40-0.81); birthweight <1500 g (RR, 0.55; 95% CI, 0.38-0.80); admission to neonatal intensive care unit (RR, 0.75; 95% CI, 0.59-0.94); and requirement for mechanical ventilation (RR, 0.66; 95% CI, 0.44-0.98). There were no significant differences between the vaginal progesterone and placebo groups in the rate of adverse maternal events or congenital anomalies. CONCLUSION : Vaginal progesterone administration to asymptomatic women with a sonographic short cervix reduces the risk of preterm birth and neonatal morbidity and mortality.
Description
Keywords
Vaginal progesterone, Midtrimester decreases, Individual patient data
Sustainable Development Goals
Citation
Romero R, Nicolaides K, Conde-Agudelo A, Tabor, A, O'Brien, JM, Cetingoz, E, Da Fonseca, E, Creasy, GW, Klein, K, Rode, L, Soma-Pillay, P, Fusey, S, Cam, C, Alfirevic, Z & Hassan, SS Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data. Am J Obstet Gynecol 2012;206:124.e1-19.