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Vaginal progesterone preterm birth

A Care, R Jackson, E O'Brien, S Leigh, C Cornforth, A Haycox, M Whitworth, T Lavender, Z Alfirevic
OBJECTIVE: To assess feasibility for a definitive randomized controlled trial (RCT) comparing three treatments for short cervix in a population at high risk for spontaneous preterm birth (sPTB) over a 1-year period. DESIGN: Three arm, open label feasibility randomized clinical study. METHODS: Women with singleton pregnancy with risk factors for sPTB (history of sPTB or prelabor premature rupture of membranes (PPROM) <34 weeks or significant cervical surgery), and short cervix on transvaginal ultrasound scan detected between 16+0 and 24+6 weeks gestation were randomized to receive either cervical cerclage, vaginal pessary, or vaginal progesterone 200 mg nocte...
March 21, 2019: Journal of Maternal-fetal & Neonatal Medicine
Anca Matei, Gabriele Saccone, Joshua P Vogel, Anthony B Armson
BACKGROUND: Preterm birth (PTB) is a leading cause of perinatal morbidity and mortality. Interventions aimed at preventing PTB can be classified as primary, secondary, or tertiary prevention. OBJECTIVE: To conduct a review of systematic reviews on the effectiveness and safety of primary and secondary preterm birth prevention interventions. SEARCH STRATEGY: A systematic literature search of the Cochrane, PubMed/Medline, EMBASE and CINAHL databases was conducted on 2 September 2015, and updated on 21 November 2016...
January 25, 2019: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Sam A Mesiano, Gregory A Peters, Peyvand Amini, Rachel A Wilson, Gregory P Tochtrop, Focco van Den Akker
In the 1930s the "progestin" hormone produced by the corpus luteum was isolated and found to be a Δ4 -keto-steroid. It was aptly named progesterone (P4) and in the following 30 years the capacity of P4 and derivatives to prevent preterm birth (PTB) was examined. Outcomes of multiple small studies suggested that progestin prophylaxis beginning at mid-gestation decreases the risk for PTB. Subsequent larger trials found that prophylaxis with weekly intramuscular injections of 17α-hydroxyprogesterone caproate (17HPC) beginning at mid-gestation decreased PTB risk in women with a history of PTB...
January 28, 2019: Placenta
Vinh Q Dang, Linh K Nguyen, Toan D Pham, Yen T N He, Khang N Vu, Minh T N Phan, Thanh Q Le, Cam H Le, Lan N Vuong, Ben W Mol
OBJECTIVE: To compare the effectiveness of cervical pessary to vaginal progesterone for the prevention of preterm birth in women with twin pregnancies and short cervix. METHODS: This randomized controlled trial was conducted at My Duc Hospital, Vietnam. Asymptomatic women with twin pregnancies and cervical length less than 38 mm were randomized to Arabin pessary or vaginal progesterone (400 mg once a day) group. The primary outcome was preterm birth at less than 34 weeks of gestation...
February 4, 2019: Obstetrics and Gynecology
Rupsa C Boelig, Lorraine Dugoff, Amanda Roman, Vincenzo Berghella, Jack Ludmir
INTRODUCTION: Second trimester asymptomatic cervical dilation is significant risk factor for early preterm birth. The objective of this study is to evaluate whether transvaginal ultrasound cervical length (CL) predicts asymptomatic cervical dilation on physical exam in women with short cervix (CL≤25mm) and no prior preterm birth. MATERIAL AND METHODS: Secondary analysis of a randomized trial on pessary in asymptomatic singletons without prior preterm birth diagnosed with CL≤25mm between 18 0/7- 23 6/7 weeks...
January 25, 2019: Acta Obstetricia et Gynecologica Scandinavica
Olga Pustotina
OBJECTIVE: The aim of this prospective study was to assess the efficacy of antibiotic therapy for the prevention of adverse pregnancy outcomes in women with the amniotic fluid "sludge" at 15-24 weeks of gestation. METHODS: 245 women underwent transvaginal ultrasound cervical length measurement at 15-24 weeks of pregnancy and 29 out of them with amniotic fluid "sludge" were included in the study. Eight women with the "sludge" had cervical length >25 mm (Group I), seven-an asymptomatic short cervix (Group IIa) and 14 women with a short cervix had symptoms like low abdominal pain, back pain, and menstrual-like cramps (Group IIb)...
January 27, 2019: Journal of Maternal-fetal & Neonatal Medicine
Thuy Hoang, Hannah Zierden, Abhijit Date, Jairo Ortiz, Sanjeev Gumber, Nicole Anders, Ping He, James Segars, Justin Hanes, Mala Mahendroo, Laura M Ensign
Preterm birth (PTB) is a significant global problem, but few therapeutic options exist. Vaginal progesterone supplementation has been demonstrated to reduce PTB rates in women with a sonographic short cervix, yet there has been little investigation into the most effective dose or delivery form. Further, vaginal products like progesterone gel often contain excipients that cause local toxicity, irritation, and leakage. Here, we describe the development and characterization of a mucoinert vaginal progesterone nanosuspension formulation for improved drug delivery to the female reproductive tract...
February 10, 2019: Journal of Controlled Release: Official Journal of the Controlled Release Society
Pankhuri Sharma, Simi Khan, Mohan Ghule, V B Shivkumar, Ritu Dargan, Paul T Seed, Archana Sarkar, Sunil Mehra, Poonam Varma Shivkumar, Rachel M Tribe
BACKGROUND: In India, 3.6 million pregnancies are affected by preterm birth annually, with many infants dying or surviving with disability. Currently, there is no simple test available for screening all women at risk of spontaneous PTB in low income setting, although high resource settings routinely use cervical length measurement and cervico-vaginal fluid fetal fibronectin for identification and care of women at risk due to clinical history. In rural India, where the public health system has limited infrastructure, trained staff and equipment, there is a greater need to develop a low-cost screening approach for providing early referral, treatment and remedial support for pregnant women at risk of preterm birth...
December 22, 2018: Reproductive Health
A H Shennan, N Suff
No abstract text is available yet for this article.
April 2019: BJOG: An International Journal of Obstetrics and Gynaecology
Alexander Jarde, Olha Lutsiv, Joseph Beyene, Sarah D McDonald
BACKGROUND: Recent progesterone trials call for an update of previous syntheses of interventions to prevent preterm birth. OBJECTIVES: To compare the relative effects of different types and routes of administration of progesterone, cerclage and pessary at preventing preterm birth in at-risk women overall and in specific populations. SEARCH STRATEGY: We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL, and Web of Science up to January 1st , 2018...
November 27, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
Nancy Medley, Joshua P Vogel, Angharad Care, Zarko Alfirevic
BACKGROUND: Preterm birth (PTB) is a major factor contributing to global rates of neonatal death and to longer-term health problems for surviving infants. Both the World Health Organization and the United Nations consider prevention of PTB as central to improving health care for pregnant women and newborn babies. Current preventative clinical strategies show varied efficacy in different populations of pregnant women, frustrating women and health providers alike, while researchers call for better understanding of the underlying mechanisms that lead to PTB...
November 14, 2018: Cochrane Database of Systematic Reviews
(no author information available yet)
No abstract text is available yet for this article.
December 2018: Obstetrics and Gynecology
A Care, L Ingleby, Z Alfirevic, A Sharp
OBJECTIVE: To identify the current status of specialist preterm labour (PTL) clinics and identify changes in management trends over the last 5 years following release of the NICE preterm birth (PTB) guidance. DESIGN: Postal Survey of Clinical Practice. SETTING: UK. POPULATION: All consultant-led obstetric units. METHODS: A questionnaire was sent by post to all 187 NHS consultant-led obstetric units...
November 20, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
N Vasudeva, C Reddington, M Bogdanska, L De Luca
One of the biggest obstetric challenges is the diagnosis and management of a short cervix as cervical length has an inverse relationship with risk of preterm birth. A cervical cerclage is a surgical procedure to reduce the risk of preterm birth and can be placed in an elective or emergency setting. This is a retrospective review of cervical cerclages inserted at an outer metropolitan hospital from February 2014 to May 2017. Since the introduction of the service, a total of 43 patients were identified as requiring a cervical cerclage...
2018: BioMed Research International
Rossana Di Sarno, Antonio Raffone, Gabriele Saccone
Different strategies have been adopted for prevention of spontaneous preterm birth, including use of progestogens. So far, five randomized trials have been published evaluating the efficacy of progestogens in women with PPROM, including a total of 425 partipants. All the five trials enrolled pregnant women with singleton pregnancies randomized between 20 and 34 weeks of gestation. In four trials women were randomized to either weekly intramuscular 250 mg 17α-hydroxyprogesterone-caproate or placebo, while Mirzaei et al...
October 11, 2018: Minerva Ginecologica
Yaniv Zipori, Roy Lauterbach, Emad Matanes, Ron Beloosesky, Zeev Weiner, Amir Weissman
INTRODUCTION: We aimed to determine whether daily vaginal progesterone use for the prevention of preterm birth has an effect on the incidence of abnormal glucose challenge test or gestational diabetes. STUDY DESIGN: A retrospective study in a large referral center. Women with cervical length ≤ 25 mm were given 200 mg vaginal micronized progesterone capsules daily at bed time until 36 weeks` gestation or delivery. Each progesterone-treated woman was matched randomly with three untreated controls...
November 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Klara Rosta, Johannes Ott, Fanni Kelemen, Wilhelm Temsch, Tobias Lahner, Theresa Reischer, Hanns Helmer, Aniko Somogyi
PURPOSE: To determine the incidence of gestational diabetes mellitus (GDM) in pregnant women who received vaginal progesterone due to short cervical length or to prevent recurrent preterm birth. METHODS: In this retrospective study, we included 190 women with singleton pregnancies at risk for preterm birth who received vaginal natural progesterone (200 mg daily between gestational weeks 16 + 0 and 36 + 0) for a minimum of 4 weeks and delivered > 28 weeks...
September 17, 2018: Archives of Gynecology and Obstetrics
Alina R Roman, Fabricio Da Silva Costa, Edward Araujo Júnior, Penelope M Sheehan
Introduction Aim of the study was to evaluate the effect of rescue adjuvant vaginal progesterone in women with ongoing, transvaginal ultrasound (TVUS)-confirmed cervical shortening despite cervical cerclage. Materials and Methods A retrospective case control study was performed of women undergoing cervical surveillance following either history- or ultrasound-indicated cervical cerclage. We compared women managed with cervical cerclage and vaginal progesterone to women managed with cervical cerclage alone. Women with a singleton pregnancy who underwent cervical cerclage were identified from a database...
August 2018: Geburtshilfe und Frauenheilkunde
Amber M Wood, Sarah K Dotters-Katz, Brenna L Hughes
OBJECTIVE:  To evaluate the risk of preterm birth in low-risk women with cervical length (CL) ≤25 mm on transvaginal ultrasound (TVUS) managed with vaginal progesterone (VagP) therapy versus cerclage. STUDY DESIGN:  This is a retrospective cohort of women with no prior history of preterm birth or cervical insufficiency and CL ≤ 25 mm on TVUS, managed with either VagP therapy alone or cerclage (with or without VagP). The primary outcome was rate of preterm delivery < 37 weeks gestational age (GA)...
January 2019: American Journal of Perinatology
Hayfaa A Wahabi, Amel A Fayed, Samia A Esmaeil, Khawater Hassan Bahkali
BACKGROUND: Miscarriage is a common complication encountered during pregnancy. It is defined as spontaneous pregnancy loss before 20 weeks' gestation. Progesterone's physiological role is to prepare the uterus for the implantation of the embryo, enhance uterine quiescence and suppress uterine contractions, hence, it may play a role in preventing rejection of the embryo. Inadequate secretion of progesterone in early pregnancy has been linked to the aetiology of miscarriage and progesterone supplementation has been used as a treatment for threatened miscarriage to prevent spontaneous pregnancy loss...
August 6, 2018: Cochrane Database of Systematic Reviews
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