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MedPulse - International Medical Journal, ISSN 2348-2516 E-ISSN: 2348-1897
Volume 1, Issue 8, Aug 2014 pp 451-454
Research Article
Role of progesterone in prevention of preterm labor among women with a short cervix
Banasree Bhadra1, Suvobrata Sarkar2, Dhrubajyoti Sarkar3, Satyashis Roy4
{1Associate Professor, 2RMO Cum Clinical Tutor, Department of Obstetrics and Gynaecology}, {3Assistant Professor, Department of Anaesthesiology}, {4Assistant Professor, Department of Radiology}, College of Medicine and JNM Hospital (COM and JNMH), Kalyani, Nadia West Bengal, INDIA.
Abstract
Introduction: Asymptomatic women found at midgestation to have a short cervix are at increased risk for spontaneous early preterm delivery. Progesterone has an essential role in maintaining pregnancy, primarily through establishing uterine quiescence. Methods: This was a prospective randomized, single-blind, placebo-controlled study for a period of three years. 248 antenatal women with a ultrasonographic measurement of short cervix (10-20mm) at 20-22 weeks of gestation, were recruited for the study. The randomization allocation was 1: 1 (vaginal progesterone capsule: placebo). Subjects were instructed to introduce one capsule into her vagina at bedtime from 24 to 36 weeks gestation. The primary outcome measure was spontaneous delivery before 34 completed weeks of gestation. Results: Out of the 8900 women who underwent sonographic measurement of cervical length between 20 to 22 weeks of gestation, 2.84% (253) were reported to have a cervical length of 10–20 mm. 248 women were included in the analysis set ( progesterone capsule, n = 125; placebo, n = 123). Patients of progesterone group had a significantly lower rate of preterm birth before 34 weeks of gestation compared to placebo group (20.8% Vs 36.5%; P = 0.006) and significantly higher rate of deliveries after 37 weeks of gestation in progesterone group compared to placebo group (60% vs 43%; P= 0.008). Neonates of progesterone group women had a significantly lower frequency of RDS than placebo group (7.2% vs 14.6%; P = 0.04). Conclusion: Routine assessment of the risk of preterm birth with cervical ultrasound along with vaginal progesterone for women with a short cervix is cost-effective. In women with a short cervix, treatment with progesterone reduces the rate of spontaneous early preterm delivery.
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