Prematurity prevention: the role of progesterone.
OBJECTIVE
This review summarizes the evidence of the effectiveness of progesterone on the rate of preterm birth and evaluates the most recent studies.


RESULTS
The incidence of preterm delivery is about 7-11% of all pregnant women and preterm birth is one of the most important causes of neonatal morbidity and mortality. Interventions to reduce such complications have been attempted for several years. Most efforts so far have been tertiary interventions, such as treatment with antenatal corticosteroids, tocolytic agents, and antibiotics. Some of these measures have reduced perinatal morbidity and mortality, but the incidence of preterm birth is increasing. Recently, researches have suggested prophylactic progesterone could reduce the preterm birth rate in a select group presenting previous preterm birth and a short cervical length by transvaginal scan at mid-trimester pregnancy.


CONCLUSIONS
This review intends to define the current indication for administration of progesterone for pregnant women. On the basis of current knowledge, progesterone should be offered to women with a documented history of a previous spontaneous birth at less than 37 weeks and for those found to have a short cervical length of 15 mm or less. Studies are needed to evaluate progesterone efficacy on other risk factors.
da Fonseca
Eduardo B
EB
Obstetric Clinic, University of São Paulo Medical School, São Paulo, Brazil. fonseca2003@yahoo.com
Bittar
Roberto E
RE
Damião
Rievani
R
Zugaib
Marcelo
M
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D009774:Obstetrics / Q000379:methods*; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D011374:Progesterone / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015149:Tocolytic Agents / Q000627:therapeutic use; D014463:Ultrasonography; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging / Q000517:prevention & control
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D015149:Tocolytic Agents; D011374:Progesterone