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By Chad Klauser Maternal Fetal Medicine physician in NYC
Maria L Brizot, Wagner Hernandez, Adolfo W Liao, Roberto E Bittar, Rossana P V Francisco, Vera L J Krebs, Marcelo Zugaib
OBJECTIVE: The purpose of this study was to investigate the use of vaginal progesterone for the prevention of preterm delivery in twin pregnancies. STUDY DESIGN: We conducted a prospective, randomized, double-blind, placebo-controlled trial that involved 390 naturally conceived twin pregnancies among mothers with no history of preterm delivery who were receiving antenatal care at a single center. Women with twin pregnancies between 18 and 21 weeks and 6 days' gestation were assigned randomly to daily vaginal progesterone (200 mg) or placebo ovules until 34 weeks and 6 days' gestation...
July 2015: American Journal of Obstetrics and Gynecology
Melanie A van Os, A Jeanine van der Ven, C Emily Kleinrouweler, Ewoud Schuit, Brenda M Kazemier, Corine J Verhoeven, Esteriek de Miranda, Aleid G van Wassenaer-Leemhuis, J Marko Sikkema, Mallory D Woiski, Patrick M Bossuyt, Eva Pajkrt, Christianne J M de Groot, Ben Willem J Mol, Monique C Haak
OBJECTIVE: The objective of this study was to evaluate the effectiveness of vaginal progesterone in reducing adverse neonatal outcome due to preterm birth (PTB) in low-risk pregnant women with a short cervical length (CL). STUDY DESIGN: Women with a singleton pregnancy without a history of PTB underwent CL measurement at 18 to 22 weeks. Women with a CL ≤ 30 mm received vaginal progesterone or placebo. Primary outcome was adverse neonatal outcome, defined as a composite of respiratory distress syndrome, bronchopulmonary dysplasia, intracerebral hemorrhage > grade II, necrotizing enterocolitis > stage 1, proven sepsis, or death before discharge...
August 2015: American Journal of Perinatology
E Schuit, S Stock, L Rode, D J Rouse, A C Lim, J E Norman, A H Nassar, V Serra, C A Combs, C Vayssiere, M M Aboulghar, S Wood, E Çetingöz, C M Briery, E B Fonseca, K Worda, A Tabor, E A Thom, S N Caritis, J Awwad, I M Usta, A Perales, J Meseguer, K Maurel, T Garite, M A Aboulghar, Y M Amin, S Ross, C Cam, A Karateke, J C Morrison, E F Magann, K H Nicolaides, N P A Zuithoff, R H H Groenwold, K G M Moons, A Kwee, B W J Mol
BACKGROUND: In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). OBJECTIVES: To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies using individual participant data meta-analysis (IPDMA). SEARCH STRATEGY: We searched international scientific databases, trial registration websites, and references of identified articles...
January 2015: BJOG: An International Journal of Obstetrics and Gynaecology
Roberto Romero, Lami Yeo, Piya Chaemsaithong, Tinnakorn Chaiworapongsa, Sonia S Hassan
Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, and its prevention is an important healthcare priority. Preterm parturition is one of the 'great obstetrical syndromes' and is caused by multiple etiologies. One of the mechanisms of disease is the untimely decline in progesterone action, which can present as a clinically silent sonographic short cervix in the midtrimester. The detection of a short cervix in the midtrimester is a powerful risk factor for preterm delivery. Vaginal progesterone can reduce the rate of preterm delivery by 45% and the rate of neonatal morbidity (admission to the neonatal intensive care unit, respiratory distress syndrome, need for mechanical ventilation, etc...
February 2014: Seminars in Fetal & Neonatal Medicine
Lindsay Maggio, Dwight J Rouse
Progestogens are a promising treatment in the prevention of spontaneous preterm birth in high-risk women. In women with a prior history of spontaneous preterm delivery and in women with a sonographic shortened cervix, there is considerable evidence supporting a benefit of progestogen therapy in the reduction of preterm delivery. In women with multifetal gestations, progestogen therapy has not been shown to be beneficial. Data are inconclusive in women with arrested preterm labor. Questions remain about the mechanism of progestogen action, the optimal type of progestogen, the best mode of administration, and the ideal dosing regimen...
September 2014: Clinical Obstetrics and Gynecology
Jay D Iams
Recognition of preterm birth as the major underlying cause of infant mortality in the United States has placed responsibility for prevention in the hands of obstetrician-gynecologists. The advent of effective methods to identify and treat women with increased risk is a major advance that will alter the focus of prenatal care. Adoption of research findings into clinical practice, never an easy task, will be particularly challenging for efforts to reduce the risk of preterm birth. Historical risk factors for preterm birth are numerous and variably defined...
June 2014: Obstetrics and Gynecology
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