Vaginal progesterone may reduce newborn complications in some pregnancies

Treatment with vaginal progesterone may help reduce certain risks that can occur when mothers are pregnant with twins and have a short cervix, which is a risk factor for preterm birth.

The findings come from an Ultrasound in Obstetrics and Gynecology meta-analysis of 6 studies encompassing 303 women pregnant with twins, all of whom had a cervical length of 25 mm or less in the midtrimester. Of these, 159 women received vaginal progesterone and 144 received a placebo or no treatment.

Women who received vaginal progesterone were 31 per cent less likely to deliver before 33 weeks of pregnancy (43 per cent of those in the placebo/no treatment group versus 31 per cent of those in the vaginal progesterone group). Vaginal progesterone also reduced the rate of preterm delivery before 32 weeks and 34 weeks.

Infants born to patients who received vaginal progesterone had a 30 per cent reduction in the rate of respiratory distress syndrome, the most common complication of prematurity (47 per cent in the placebo/no treatment group versus 33 per cent in the vaginal progesterone group), a 46 per cent reduction in the rate of mechanical ventilation (27 per cent in the placebo/no treatment group versus 16 per cent in the vaginal progesterone group), and a 4 per cent reduction in the risk of dying in the neonatal period (22 per cent in the placebo/no treatment group versus 11 per cent in the vaginal progesterone group).

“To date, clinical practice and national recommendations to prevent preterm birth and reduce related adverse outcome in twin pregnancies vary significantly because of a lack of convincing scientific evidence and regional variation in the interpretation of said evidence,” said Basky Thilaganathan, Ultrasound in Obstetrics and Gynecology’s Editor-in-Chief. “The findings of this individual patient data meta-analysis provide scientific evidence that treatment with vaginal progesterone in women with a short cervix and a twin pregnancy reduces the frequency of preterm birth and related serious adverse perinatal outcomes.”

Source: Wiley

Reference: R. Romero, A. Conde-Agudelo, W. El-Refaie, L. Rode, M. L. Brizot, E. Cetingoz, V. Serra, E. Da Fonseca, M. S. Abdelhafez, A. Tabor, A. Perales, S. S. Hassan and K. H. Nicolaides. Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data. Ultrasound in Obstetrics and Gynecology. DOI: 10.1002/uog.17397

Staff Writer