Role of progestogens in women at risk for spontaneous preterm birth: the final word?

Abstract

Preterm birth is defined by WHO as delivery before 37 weeks of gestation. 1 WHO: recommended definitions, terminology and format for statistical tables related to the perinatal period and use of a new certificate for cause of perinatal deaths, modifications recommended by FIGO as amended October 14, 1976. Acta Obstet Gynecol Scand. 1977; 56: 247-253 PubMed Google Scholar It is one of the most common pregnancy complications, with an estimated global rate of 10·6% in 2014, equating to an estimated 14·84 million live preterm births. 2 Chawanpaiboon S Vogel JP Moller AB et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019; 7: 37-46 Summary Full Text Full Text PDF PubMed Scopus (962) Google Scholar Preterm birth considerably increases risk of neonatal morbidity and mortality, including long-term sequelae, and can result in long-term health and financial implications for families. 3 Goldenberg RL Culhane JF Iams J Romero R The epidemiology and etiology of preterm birth. Lancet. 2008; 371: 75-84 Summary Full Text Full Text PDF PubMed Scopus (4622) Google Scholar Evaluating Progestogens for Preventing Preterm birth International Collaborative (EPPPIC): meta-analysis of individual participant data from randomised controlled trialsVaginal progesterone and 17-OHPC both reduced birth before 34 weeks' gestation in high-risk singleton pregnancies. Given increased underlying risk, absolute risk reduction is greater for women with a short cervix, hence treatment might be most useful for these women. Evidence for oral progesterone is insufficient to support its use. Shared decision making with woman with high-risk singleton pregnancies should discuss an individual's risk, potential benefits, harms and practicalities of intervention. Full-Text PDF