Progesterone Gel Greatly Reduces Preterm Birth Rate
According to the March of Dimes, 1 of 8 babies is born too early. New research promises to have a substantial effect on preterm births and the neonatal complications related to them.
At the 2011 meeting of the American College of Obstetricians and Gynecologists, Roberto J. Romero, MD, Program Director for Obstetrics and Perinatology at the National Institutes of Health (NIH), presented results from a new NIH study showing that vaginal progesterone gel can prevent preterm birth by as much as 50%.
“Preterm birth is the most challenging problem in obstetrics,” Dr Romero said. “Its frequency is unchanged in 20 years. It occurs in about 12% of live births.” Dr Romero delivered the Anna Marie D’Amico Lecture at the meeting and received a standing ovation for his presentation.
Short cervix and progesterone deficiency play key roles in preterm birth, according to Dr Romero Cervical length ≤15 mm is associated with a 50% risk for preterm delivery, and progesterone is essential for pregnancy maintenance.
“A short cervix represents an untimely decline in cervical ripening that responds to treatment,” he said.
Normal-length cervix
Short cervix
This multicenter study (Hassan SS, et al. Ultrasound Obstet Gynecol. 2011 Apr 6. Epub ahead of print) showed that daily vaginal progesterone gel use in women with a short cervix was associated with rate of respiratory distress syndrome.
A total of 458 women with short cervix (10-20 mm) received daily treatment with vaginal progesterone gel or placebo initiated at 20 0/7 and 23 6/7 weeks gestation through 36 6/7 weeks.
The rate of premature delivery was reduced significantly with progesterone. The table lists the rate for deliveries at gestational age <35 weeks, <33 weeks, and <28 weeks. In addition, progesterone gel reduced the rate of respiratory distress by 61%—7.6% with placebo versus 3.0% with progesterone gel.
Several other infant outcomes were also significantly improved with pro - gesterone gel; adverse event rates were similar in the 2 groups. “The implications of the study are 2- fold,” Dr Romero said. “One, we can screen for risk with cervical ultrasound. Remember, 60% of all preterm infants are born to mothers in their first pregnancy, so we cannot depend on previous history. And two, a single intervention can make a big difference.”
Although some experts have ex - pressed concerns that this treatment will be expensive, Dr Romero said that screening and intervention will be cost-effective if the cost of the scans can be limited to ≤$184.