Prophylactic progesterone and preterm labor in low-risk twin pregnancies

Abstract

Objectives The aim of the study was to study the role of vaginal progesterone versus placebo in preventing preterm birth in twin pregnancies with a normal cervical length in the second trimester and its neonatal outcome. Study design The study was designed as a randomized controlled trial. Patients and methods A total of 100 women with twin pregnancies were enrolled and randomized to receive daily either 200 mg vaginal progesterone or placebo for 10 weeks from 24–34 weeks of gestation. They all underwent detailed first and second trimester anomaly scans and cervical length assessment. Patients with anomalies, monochorionic twins, medical disorders, or a cervical length less than 25 mm were excluded. Results Patients’ demographic details, age, weight, parity, and previous risk factors were not statistically different between the two groups. The mean cervical length was 34 mm in the progesterone group and 36 mm in the placebo group. Mean gestational age at delivery was 35.7 weeks with a mean birth weight of 2160 g in the progesterone group, which was not significantly different from the placebo group with a mean gestational age of 35.6 weeks and a mean birth weight of 2210 g. Fetal complications or neonatal ICU admissions were not different in the two groups. Conclusion Although vaginal progesterone reduces preterm birth and neonatal complications in singletons with a short cervix, its role in twin pregnancies with a normal cervical length is unclear and needs a larger study to prove its merit.