Administration
of vaginal progesterone to asymptomatic women with a twin gestation and a
sonographic short cervix (cervical length ≤ 25 mm) in the mid-trimester reduces
the risk of preterm birth occurring at < 30 to < 35 gestational weeks,
neonatal mortality and some measures of neonatal morbidity, without any
demonstrable deleterious effects on childhood neurodevelopment.
The article
was published online in Ultrasound in Obstetrics and Gynecology, the official
journal of the International Society of Ultrasound in Obstetrics and Gynecology
(ISUOG).
The
meta-analysis included the results of 6 studies, encompassing 303 women
pregnant with twins, all of whom had a cervical length of 25 mm or less in the
midtrimester. Of these, 159 women received vaginal progesterone and 144
received a placebo or no treatment. Women who received vaginal progesterone
were 31 percent less likely to deliver before 33 weeks of pregnancy (31 percent
for those receiving vaginal progesterone, compared to 43 percent for those who
did not). Vaginal progesterone also reduced the rate of preterm delivery before
32 weeks and 34 weeks. All results were statistically significant.
The risk of
preterm birth < 33 weeks was reduced by 31% and neonatal death by 47% and
also reduced the rate of respiratory distress syndrome (RDS), birth weight <
1500 g and use of mechanical ventilation.
No
significant difference in the risk of neurodevelopmental disability at 4–5
years of age between children exposed prenatally to vaginal progesterone and
those exposed to placebo.
“The
findings represent persuasive evidence that treatment with vaginal progesterone
in women with a short cervix and a twin gestation reduces the frequency of
preterm birth, neonatal complications such as respiratory distress syndrome,
and importantly, neonatal death,” said the study’s first author, Roberto
Romero, M.D., Chief of the Perinatology Research Branch at the Eunice Kennedy
Shriver National Institute of Child Health and Human Development (NICHD/NIH).
Dr. Romero emphasized that individual patient data meta-analyses represent the “gold
standard” in the hierarchy of scientific evidence to answer clinical questions.
Access the
full article.
Access the
press release.
The accompanying
videoclip by the ISUOG summarizes the importance of research.
