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Previous Volume 357:462-469 August 2, 2007 Number 5 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Thornton, J. G. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Previous randomized trials have shown that progesterone administration in women who previously delivered prematurely reduces the risk of recurrent premature delivery. Asymptomatic women found at midgestation to have a short cervix are at greatly increased risk for spontaneous early preterm delivery, and it is unknown whether progesterone reduces this risk in such women.

Methods Cervical length was measured by transvaginal ultrasonography at a median of 22 weeks of gestation (range, 20 to 25) in 24,620 pregnant women seen for routine prenatal care. Cervical length was 15 mm or less in 413 of the women (1.7%), and 250 (60.5%) of these 413 women were randomly assigned to receive vaginal progesterone (200 mg each night) or placebo from 24 to 34 weeks of gestation. The primary outcome was spontaneous delivery before 34 weeks.

Results Spontaneous delivery before 34 weeks of gestation was less frequent in the progesterone group than in the placebo group (19.2% vs. 34.4%; relative risk, 0.56; 95% confidence interval [CI], 0.36 to 0.86). Progesterone was associated with a nonsignificant reduction in neonatal morbidity (8.1% vs. 13.8%; relative risk, 0.59; 95% CI, 0.26 to 1.25; P=0.17). There were no serious adverse events associated with the use of progesterone.

Conclusions In women with a short cervix, treatment with progesterone reduces the rate of spontaneous early preterm delivery. (ClinicalTrials.gov number, NCT00422526 [ClinicalTrials.gov] .)

Source Information

From the Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London.

Address reprint requests to Dr. Nicolaides at the Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, Denmark Hill, London SE5 8RX, United Kingdom, or at kypros{at}fetalmedicine.com.

Full Text of this Article

Related Letters:

Progesterone and Preterm Birth
O'Brien J. M., Chandiramani M., Tribe R., Shennan A., Nicolaides K. H., Celik E., Fonseca E. B., Rouse D. J., Thom E. A., Spong C. Y., the NICHD Maternal Fetal Medicine Units Network
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N Engl J Med 2007; 357:2306-2307, Nov 29, 2007. Correspondence

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