Vaginal progesterone for the prevention of recurrent spontaneous preterm birth.

After the FDA pulled 17-hydroxyprogesterone caproate from the market for its use in prevention of recurrent spontaneous preterm birth, national societies have had mixed recommendations regarding the management of patients with a singleton pregnancy and prior spontaneous preterm birth. Here we highlight the randomized trial data and translational evidence supporting the use of vaginal progesterone for prevention of recurrent spontaneous preterm birth in singleton pregnancies. Prophylactic vaginal progesterone starting at 16 week 0 days every night should be offered to singletons with prior singleton spontaneous preterm birth regardless of cervical length, and continued along with placement of cerclage if a transvaginal ultrasound cervical length ≤25mm is detected at < 24 weeks.