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Prevention of recurrence of pre-term birth by progesterone

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  1. Abstract
  2. Physiopathological justification of the use of progesterone to prevent preterm birth
  3. Studies on the use of progesterone as tocolytique
  4. Studies on the use of progesterone in prevention of recurrent preterm delivery
  5. The older studies
  6. Recent studies
  7. Risks associated with the use of progesterone during pregnancy
  8. Strategies for preventing recurrent preterm delivery
  9. Conclusion
  10. References

For years, the prescription of progesterone in the event of a threat of premature birth was normal, despite the absence of any demonstration of a fetal or neonatal benefit in this situation. The description of an increased risk of cholestasis of pregnancy during this treatment was terminated this requirement.

Recently, several randomized double-blind study showed a benefit of progesterone in preventing the risk of recurrence of prematurity. This review includes the physiopathological justification of the use of progesterone, discusses the biases and limitations of earlier studies and describes the two recent randomized trials which could use progesterone "fashionable."

The data from these trials do not seem convincing that the preventive use of 17 alpha-hydroxyprogesterone injection started early during pregnancy in women with a history of prematurity. This requirement could be integrated in a more comprehensive preventive strategy in which the cervical cerclage and preventive treatment of bacterial vaginosis may also have their place.

[...] Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: A randomized placebo-controlled double-blind study. Am J Obstet Gynecol 2003; 188: 419- Meis PJ, Klebanoff Thom Dombrowski MP, Sibai Moawad AH et al. Prevention of recurrent preterm delivey by 17 alpha- hydroxyprogesterone caproate. N Engl J Med 2003; 348: 2379- AI Csapo. Progesterone block. Am J Anat 1956; 98: 273- Garfield RE, Dannan MS, Daniel EE. Gap-junction formation in myometrium: Control by estrogens, progesterone, and prostaglandins. [...]


[...] Effects of progesterone on prostaglandin E2 - induced changes in glycosaminoglycan production by human cervical fibroblasts in culture. Mol Hum Reprod 2000; 661- Erny Pigne Prouvost Gamerre Malet Serment H et al. The effects of oral administration of progesterone for premature labor. Am J Obstet Gynecol 1986; 154: 525- Mitchell Cruickshank McLain, Challis JRG. Local modulation of progesterone production in human fetal membranes. J Clin Endocrinol Metab 1982; 55: 1237- Frydman Lelaidier Baton-Saint-Mleux Fernandez Vial Bourget P. Labor induction in women at term with mifepristone (RU 486) : a double-blind, randomized, placebo-controlled study. [...]


[...] The use of progesterone to tocolysis for once the threat of premature birth installed has no scientific justification from reading these studies. The methodological quality of this work remains questionable with inadequate methods of randomization and posts more often too small to suggest that the lack of difference due to the ineffectiveness of treatment rather than lack of power of the comparison. Studies on the use of progesterone in prevention of recurrent preterm delivery Two periods can be distinguished: that of 50 to 90 years during which many small trials have been published without giving definitive finding, and in 2003 that saw the publication of two large trials provide evidence of substantial arguments in favor of the effectiveness of progesterone in preventing premature births. [...]

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