Vaginal Progesterone May Help Certain Patients


New research has identified a select group of patients who may benefit from vaginal progesterone to reduce the risk of preterm birth.

By using progesterone, physicians may be able to reduce the risk of preterm birth for women who are pregnant with twins and have a short cervix, a review of past studies has found.

While researchers reaffirmed that progestin hormones will not reduce preterm births for most pregnancies, they did unearth the caveat among this subgroup of high-risk pregnancies.

After reviewing 13 trials, which included more than 3,700 women pregnant with twins, the authors found that for women with a cervical length of 25 mm or less, the use of vaginal progesterone reduced the risk of adverse perinatal outcome. The finding was statistically significant when cervical length was measured at randomization and when cervical length was measured before 24 weeks' gestation.

Key Findings

- Using vaginal progesterone may reduce adverse perinatal outcomes related to preterm birth among women who are pregnant with twins and have a short cervix.

- This finding needs to be replicated to confirm the benefit of this intervention.

The authors noted that by using progestin hormones, clinicians were able to reduce the risk of preterm birth by 50% among the small cohort of women who have both a short cervix and are pregnant with twins.

“That's a very significant result, and one that we hope will help to save lives and prevent future heartache for couples who are trying to have children," said coauthor Ben Mol, MD, PhD, in a prepared statement.

Still, because the success of using progesterone for this specific population was not the focus of any one study, the findings would have to be replicated to confirm the practice as beneficial.

“While it does not help to reduce risk in all twin pregnancies, it does help to significantly reduce poor outcomes for those twin pregnancies in a very high risk group," Mol said.

The discovery was published in BJOG: An International Journal of Obstetrics & Gynaecology.

Besides noting the previously unknown benefit, the authors reported that the meta-analysis confirmed that among unselected, uncomplicated twin pregnancies, neither 17-hydroxyprogesterone caproate nor vaginal natural progesterone reduced the incidence of adverse perinatal outcome.

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