Document Detail


A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix.
MedLine Citation:
PMID:  23314512     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, and is the most important challenge to modern obstetrics. A major obstacle has been that preterm birth is treated (implicitly or explicitly) as a single condition. Two thirds of preterm births occur after the spontaneous onset of labor, and the remaining one third after "indicated" preterm birth; however, the causes of spontaneous preterm labor and "indicated" preterm birth are different. Spontaneous preterm birth is a syndrome caused by multiple etiologies, one of which is a decline in progesterone action, which induces cervical ripening. A sonographic short cervix (identified in the midtrimester) is a powerful predictor of spontaneous preterm delivery. Randomized clinical trials and individual patient meta-analyses have shown that vaginal progesterone reduces the rate of preterm delivery at <33 weeks of gestation by 44%, along with the rate of admission to the neonatal intensive care unit, respiratory distress syndrome, requirement for mechanical ventilation, and composite neonatal morbidity/mortality score. There is no evidence that 17-α-hydroxyprogesterone caproate can reduce the rate of preterm delivery in women with a short cervix, and therefore, the compound of choice is natural progesterone (not the synthetic progestin). Routine assessment of the risk of preterm birth with cervical ultrasound coupled with vaginal progesterone for women with a short cervix is cost-effective, and the implementation of such a policy is urgently needed. Vaginal progesterone is as effective as cervical cerclage in reducing the rate of preterm delivery in women with a singleton gestation, history of preterm birth, and a short cervix (<25 mm).
Authors:
Roberto Romero; Lami Yeo; Jezid Miranda; Sonia S Hassan; Agustin Conde-Agudelo; Tinnakorn Chaiworapongsa
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Intramural; Review    
Journal Detail:
Title:  Journal of perinatal medicine     Volume:  41     ISSN:  1619-3997     ISO Abbreviation:  J Perinat Med     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-14     Completed Date:  2013-08-16     Revised Date:  2014-09-03    
Medline Journal Info:
Nlm Unique ID:  0361031     Medline TA:  J Perinat Med     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  27-44     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
17-alpha-Hydroxyprogesterone / administration & dosage*
Administration, Intravaginal
Cervix Uteri / abnormalities,  ultrasonography
Female
Humans
Pregnancy
Pregnancy, High-Risk
Premature Birth / prevention & control*
Risk
Grant Support
ID/Acronym/Agency:
ZIA HD002400-22/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
68-96-2/17-alpha-Hydroxyprogesterone
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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