Is Vaginal Progesterone More Effective to Treat Threatened Preterm Labour than Oral Nifedipine?

Abstract

Objective: To compare the effectiveness of vaginal progesterone versus oral nifedipine in the treatment of threatened preterm labor (TPL).
 Methodology: This randomized control trial was carried out at Gynae and OBS department of Ibn-E-Siena Hospital, Multan, during a period of six months from December 2020 to June 2021. Participants were randomly allocated to either the vaginal progesterone group or the oral nifedipine group using computer-generated randomization. In Group A, participants received oral nifedipine at a dose of 20mg every 30 minutes for three initial doses, followed by long-acting nifedipine SR 20mg every 12 hours until reaching 37 weeks of gestational age or until cervical dilation exceeded 4cm. In Group B, participants were instructed to use vaginal micronized progesterone tablets at a dosage of 200mg once daily until reaching 37 weeks of gestational age or until cervical dilation exceeded 4cm. Effectiveness, refers to the ability of each treatment option to successfully prolong pregnancy duration in cases of threatened preterm labor.
 Results: The mean age of the subjects was 29.6 years, with a standard deviation of 5.44 years. Mean gestational age was 33.32 weeks. In Group A, oral nifedipine showed effectiveness in (73.0%) of the cases. Conversely, Group B, which received vaginal progesterone, exhibited significantly higher efficacy rates, among 57 (90.5%) of the patients (p-value of 0.011). Effectiveness among two treatment modalities was found to be statistically insignificant according to age and parity of the women (p=>0.05).
 Conclusion: Study revealed a significant difference in efficacy between the two treatment modalities. Specifically, vaginal progesterone demonstrates superior efficacy compared to oral nifedipine, which underscores the potential advantages of vaginal progesterone in managing threatened preterm labor.