Abstract
Objective: To evaluate whether prophylactic administration of 200 mg vaginal progesterone can reduce the incidence of preterm birth in women with documented history of preterm birth <37 weeks of gestation or not. Setting: Obstetrics and Gynecology Department, Zagazig University Hospital, Egypt. Methods: Ninety patients with previous history of preterm birth prior to 37 week presenting with singleton pregnancy between 20 - 24 weeks were randomly allocated to receive either the progesterone 200 mg vaginal suppository or no treatment. Results: The incidence of preterm labor before 37 weeks of gestation was significantly lower in the study group than in the control group (22.2% vs. 53.3%) especially in earlier gestational ages. While, the mean birth weight was significantly higher in the study group than in control group (2872.67 ± 565.76 gm vs. 2487.78 ± 742.40 gm). The neonatal morbidities and mortality associated with preterm labor were significantly lower in the study group than in the control group as shown by lower incidence of neonatal RDS (13.3% vs. 31.1%; P = 0.043) and lower incidence of the need for NICU admission (15.6% vs. 35.5%; P = 0.03). Conclusion: Administration of prophylactic vaginal progesterone (200 mg, daily) can significantly reduce the rate of preterm birth before 37, 32 and 28 wks of gestation among women with previous spontaneous preterm birth. In addition, the rates of RDS and admission to NICU were significantly decreased among infants of women assigned to progesterone treatment. Also, there was an additional benefit of vaginal progesterone for prevention of preterm birth in women who had prior spontaneous preterm birth and cervical length < 25 mm.
Highlights
Preterm birth, according to WHO, is defined as birth prior to 37 completed weeks of gestation
The rates of RDS and admission to NICU were significantly decreased among infants of women assigned to progesterone treatment
There was an additional benefit of vaginal progesterone for prevention of preterm birth in women who had prior spontaneous preterm birth and cervical length < 25 mm
Summary
Preterm birth, according to WHO, is defined as birth prior to 37 completed weeks of gestation. Preterm delivery is the single most important obstetrical complication leading to perinatal morbidity and mortality [1]. Preterm births account for 70% of neonatal deaths and 25% - 50% of cases of long-term neurological impairment in children [2]. The prevalence of preterm birth is about 7% - 12% of all deliveries and one third of these occur before 34 completed weeks. The prevalence in developing countries is higher [1]. There has been an increase in the incidence of preterm birth over the last decade [3]
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