Intramuscular 17Alpha-hydroxyprogestrone, Progesterone suppositories and Dydrogesterone tablets in preventing Preterm labor: Randomized Control Trial

Abstract

P retermbirthisthemajorcauseofneonatalmortalityandmorbidity.AhistoryofapriorspontaneousPTBremainsthegreatestriskfactorforspontaneousPTB,Thesehigh-riskwomenhavebeenthefocusofrecenttrialsforthepreventionofrecurrentprematurity. In2009,13millionbabieswerebornpreterm,11millioninAfricaandAsiaand500,000intheUSA,ThehighestratesofpretermbirthareinAfrica(11.9%)andNorthAmerica(10.6%). Prematurityrepresentsamajorcauseofperinataldeathandlongtermhandicap.AlthoughtheincidenceofpretermLaborhasnotchangedovermanyyears,neonatologyhasadvanced,andthesurvivalofbabieshasimproved.Yet,handicapscontinuetooccurinbabiesbornatveryearlygestationalages.Themajorityofproblemsfacingpretermneonatesaremainlyduetoorganimmaturity,particularlythelungs,anditseemsclearthattheseverityisinverselyproportionaltogestationalages. Preventionisdirectedtowardsidentificationofwomenatriskrecentstudieshaveidentifiedclinical,sonographic,andbiochemicalmarkersthathelptoidentifythewomenathighestrisk.Determiningcervicallengthandmeasuringcervicovaginalfibronectinhavebeenproposedasusefultoolsforevaluatingwomenatriskofpretermbirthandmayidentifythosewhomightbenefitfromantenatalcorticosteroids,buteffectiveinterventionstopreventpretermbirthremainelusive. ThetreatmentofestablishedpretermLaborshouldbedirectedtowardsidentifyingthosewomeninwhomadelayindeliveryislikelytobebeneficialandthoseinwhomitmaybelethalintermsofneonatalorinfantoutcome.Althoughthereislittlehardevidencethattocolysisimprovestheoutcomeforthebaby,mostobstetricianstreatthreateneduncomplicatedpretermLaborinordertoadministersteroidsortransferthemothertoanappropriatehospital. SeveraltrialshaveshownareductioninspontaneousPTBusingvariousformulationsofprogesterone,offeringprogesteronesupplementationtowomenwithapriorspontaneousPTBisnowrecommendedbyAmericanCollegeofObstetriciansandGynecologists. Natural(micronized)progesteroneisidenticaltotheprogesteroneproducedbytheplacentaandcorpusluteumandsoisreadilymetabolizedandassociatedwithminimalsideeffects. Therehasbeenarecentreappearanceofinterestintheuseofprogesteronesupplementationtopreventpretermdeliveryinhigh-riskpatientsasevidencedbytworecenttrials;theresultsofdaFonsecastudyandtheMeistrialsupportthehypothesisthatprogesteronesupplementationreducespretermbirthinaselectveryhigh-riskgroupofwomen.