The Use of Progesterone for Prevention of Preterm Birth

ObjectiveTo introduce new information on the use of progesterone to prevent premature labour and to provide guidance to obstetrical caregivers who counsel women on the merits of this choiceOptionsThis discussion is limited to progesterone therapy for prevention of preterm labour (PTL) in women at increased risk of PTL.EvidenceA search of both Medline and the Cochrane Library identified the most relevant medical evidence. This document represents an abstraction of the evidence rather than a methodological review. The level of evidence and quality of recommendations are described using the criteria and classifications of the Canadian Task Force on Preventive Health Care (Table 1).ValuesThis update is the consensus of the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC).Benefits, Harms, and CostsCounselling the patient at increased risk for PTL should include consideration of the potential benefits of progesterone use and our lack of/limited knowledge of many neonatal outcomes and optimal dosing.SponsorSociety of Obstetricians and Gynaecologists of Canada.Recommendations1.Women at risk for PTL should be encouraged to participate in studies on the role of progesterone in reducing the risks of preterm labour. (I-A)2.Women should be informed about the lack of available data for many neonatal outcome variables and about the lack of comparative data on dosing and route of administration. Women with short cervix should be informed of the single large RCT showing the benefit of progesterone in preventing PTL. (I-A)3.Women and their caregivers should be aware that a previous preterm labour and/or short cervix (< 15 mm at 22-26 weeks' gestation) on transvaginal ultrasound could be used as an indication for progesterone therapy. The therapy should be started after 20 weeks' gestation and stopped when the risk of prematurity is low. (I-A)4.On the basis of the data from the RCTs and meta-analysis, it is recommended that in cases where the clinician and the patient have opted for the use of progesterone the following dosages should be used:
- For prevention of PTL in women with history of previous PTL: 17 alpha- hydroxyprogesterone 250 mg IM weekly (IB) or progesterone 100 mg daily vaginally. (I-A)
- For prevention of PTL in women with short cervix of <15 mm detected on transvaginal uktrasound at 22-26 weeks progesterone 200 mg daily vaginally. (I-A)