Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Research Article Volume 5 Issue 2

The Use of Vaginal Progesterone in Risk Reduction of Preterm Birth in Pregnant Women with Short Cervix

Sana Monem1 and Chro Najmaddin Fattah2*

1Diploma in Obstetrics and Gynecology, Sulaimani Maternity Teaching Hospital, Sulaimani, Kurdistan Region, Iraq
2Assistant Professor, Head of Department, Obstetrics and Gynaecology, Medical School, University of Sulaimani, Kurdistan Region, Iraq

*Corresponding Author: Chro Najmaddin Fattah, Assistant Professor, Head of Department, Obstetrics and Gynaecology, Medical School, University of Sulaimani, Kurdistan Region, Iraq.

Received: November 23, 2020; Published: January 28, 2021

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Abstract

Background: Preterm labour is a major health challenge in obstetrics. Many risk factors being identified, the most common one is short cervical length, can be diagnosed by transvaginal ultrasound scan after 13 weeks of pregnancy. Vaginal progesterone is the most bioavailable form of progesterone that have effect on uterine and cervix. Progesterone is thought to inhibit the production of proinflammatory cytokines and prostaglandins within the uterus and to inhibit myometrial contractility

Objectives: The objective of this study is to assess the usefulness of vaginal progesterone suppositories in reduction of preterm birth in asymptomatic singleton pregnancy women with short cervix.

Patients and Methods: This is a study on the daily use of (100mg or 200mg) of vaginal progesterone by 79 women in a prospective Randomized Controlled study. Between 24-34 weeks of gestation with short cervix of <29mm confirmed by transvaginal ultrasound and followed prospectively.

Result: Preterm labour among vaginal progesterone group were less but statistically nonsignificant. The preterm labour among who received 100 mg was significantly lower than other 200mg.

Conclusion: The study found the advantage of progesterone pessary in a women with short cervical length <25 mm in mid-trimester of pregnancy with no history of preterm labour.

Keywords: Preterm Birth; Progesterone; Short Cervix; Cervical Length (CL)

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References

  1. Myles Taylor. Preterm labour. David M Luesley. An evidence-based text for MRCOG. 2nd Edi. Euston Road London. Pub Hodder Arnold (2010): 299-300.
  2. Preterm birth (2018).
  3. Romero R., et al. “Preterm labor: one syndrome, many causes”. Science 345 (2014): 760-765.
  4. World Health Organization. Born Too Soon: The Global Action Report on Preterm Birth. Geneva: WHO, 2012.
  5. Liu L., et al. “Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals”. Lancet 10063 (2016): 3027-3035.
  6. Esplin MS., et al. “Predictive accuracy of serial transvaginal cervical lengths and quantitative vaginal fetal fibronectin levels for spontaneous preterm birth among nulliparous women”. JAMA 317 (2017): 1047-1056.
  7. Mayo Foundation for Medical Education and Research 1998-2019 (MFMER).
  8. Clement S., et al. “Transvaginal ultrasound in pregnancy: its acceptability to women and maternal psychological morbidity”. Ultrasound Obstetrics and Gynecology 22 (2003): 508-514.
  9. Alfirevic Z., et al. “Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy”. Cochrane Database System Review 4 (2012): CD008991.
  10. Sfakianaki AK and Norwitz ER. “Mechanisms of progesterone action in inhibiting prematurity”. Journal of Maternal-Fetal and Neonatal Medicine 19 (2006): 763-772.
  11. Tulchinsky D and Hobel CJ. “Plasma human chorionic gonadotropin, estrone, estradiol, estriol, progesterone, and 17 alpha-hydroxyprogesterone in human pregnancy. 3. Early normal pregnancy”. American Journal of Obstetrics and Gynecology7 (1973): 884-893.
  12. Johansson ED. “Plasma levels of progesterone in pregnancy measured by a rapid competitive protein binding technique”. Acta Endocrinology (Copenh) 61.4 (1969): 607-617.
  13. F Gary Cunningham., et al. “Placental progesterone production. Williams Obstetrics, Twenty-Fifth Edition (2018): 102-103.
  14. Elovitz MA and Mrinalini C. “The use of progestational agents for preterm birth: lessons from a mouse model”. American Journal of Obstetrics and Gynecology4 (2006): 1004-1010.
  15. Hanna J., et al. “Decidual NK cells regulate key developmental processes at the human fetalmaternal interface”. Nature Medicine9 (2006): 1065-1074.
  16. Croy BA., et al. “Decidual natural killer cells: key regulators of placental development (A review)”. Journal of Reproductive Immunology 57 (2002): 151-168.
  17. F Gary Cunningham., et al. Williams Obstetrics, Twenty-Fifth Edition 2018. Prophylaxis with progesterone compounds, Chapter 42 (2018): 816.
  18. FIGO Working Group on Best Practice in Maternal-Fetal Medicine; International Federation of Gynecology and Obstetrics. Best practice in maternal-fetal medicine. International Journal of Gynecology and Obstetrics 128 (2015): 80-82.
  19. National Institute for Health and Care Excellence. Preterm labor and birth (2015).
  20. Cicinelli E., et al. “Direct transport of progesterone from vagina to uterus”. Obstetrics and Gynecology 95 (2000): 403-406.
  21. Fanchin RM., et al. “Transvaginal administration of progesterone”. Obstetrics and Gynecology 90 (1997): 396-401.
  22. R Romero., et al. “Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta‐analysis of individual patient data”. Ultrasound in Obstetrics and Gynecology 3 (2017): 303-314.
  23. Meena Khandelwal. “Vaginal progesterone in risk reduction of preterm birth in women with short cervix in the midtrimester of pregnancy”. International Journal of Women's Health 4 (2012): 481-490.
  24. VCF Heath., et al. “Cervical length at 23 weeks of gestation: relation to demographic characteristics and previous obstetric history. Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital Medical School, London, UK”. Ultrasound in Obstetrics and Gynecology 12 (1998): 304-311.
  25. Danish-Austrian Klein K., et al. “Vaginal micronized progesterone and risk of preterm delivery in high-risk twin pregnancies: secondary analysis of a placebo-controlled randomized trial and meta-analysis. Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria”. Ultrasound in Obstetrics and Gynecology 3 (2011): 281-287.
  26. Hassan SS., et al. “Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial”. Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, USA 38.1 (2011): 18-31.
  27. Romero R., et al. “Vaginal progesterone decreases preterm birth ≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study”. USA 48.3 (2016): 308-317.
  28. Conde-Agudelo A., et al. “Vaginal progesterone vs. cervical cerclage for the prevention of preterm birth in women with a sonographic short cervix, previous preterm birth, and singleton gestation: a systematic review and indirect comparison meta-analysis Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA”. American Journal of Obstetrics and Gynecology1 (2013): 42.e1-42.e18.
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Citation

Citation: Sana Monem and Chro Najmaddin Fattah. “The Use of Vaginal Progesterone in Risk Reduction of Preterm Birth in Pregnant Women with Short Cervix”.Acta Scientific Medical Sciences 5.2 (2021): 85-91.




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Acceptance rate30%
Acceptance to publication20-30 days
Impact Factor1.111

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