title: Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data.
abstract: OBJECTIVE
  To determine whether the use of vaginal progesterone in asymptomatic women with a sonographic short cervix (≤ 25 mm) in the midtrimester reduces the risk of preterm birth and improves neonatal morbidity and mortality.
  
  
  METHODS
  Individual patient data metaanalysis of randomized controlled trials.
  
  
  RESULTS
  Five trials of high quality were included with a total of 775 women and 827 infants. Treatment with vaginal progesterone was associated with a significant reduction in the rate of preterm birth <33 weeks (relative risk [RR], 0.58; 95% confidence interval [CI], 0.42-0.80), <35 weeks (RR, 0.69; 95% CI, 0.55-0.88), and <28 weeks (RR, 0.50; 95% CI, 0.30-0.81); respiratory distress syndrome (RR, 0.48; 95% CI, 0.30-0.76); composite neonatal morbidity and mortality (RR, 0.57; 95% CI, 0.40-0.81); birthweight <1500 g (RR, 0.55; 95% CI, 0.38-0.80); admission to neonatal intensive care unit (RR, 0.75; 95% CI, 0.59-0.94); and requirement for mechanical ventilation (RR, 0.66; 95% CI, 0.44-0.98). There were no significant differences between the vaginal progesterone and placebo groups in the rate of adverse maternal events or congenital anomalies.
  
  
  CONCLUSIONS
  Vaginal progesterone administration to asymptomatic women with a sonographic short cervix reduces the risk of preterm birth and neonatal morbidity and mortality.
authors.affiliation: Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.forename: Kypros
authors.initials: K
authors.lastname: Nicolaides
authors.forename: Agustin
authors.initials: A
authors.lastname: Conde-Agudelo
authors.forename: Ann
authors.initials: A
authors.lastname: Tabor
authors.forename: John M
authors.initials: JM
authors.lastname: O'Brien
authors.forename: Elcin
authors.initials: E
authors.lastname: Cetingoz
authors.forename: Eduardo
authors.initials: E
authors.lastname: Da Fonseca
authors.forename: George W
authors.initials: GW
authors.lastname: Creasy
authors.forename: Katharina
authors.initials: K
authors.lastname: Klein
authors.forename: Line
authors.initials: L
authors.lastname: Rode
authors.forename: Priya
authors.initials: P
authors.lastname: Soma-Pillay
authors.forename: Shalini
authors.initials: S
authors.lastname: Fusey
authors.forename: Cetin
authors.initials: C
authors.lastname: Cam
authors.forename: Zarko
authors.initials: Z
authors.lastname: Alfirevic
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Hassan
mesh_terms: D000282:Administration, Intravaginal; D005260:Female; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000517:prevention & control*; D011374:Progesterone / Q000008:administration & dosage / Q000627:therapeutic use*; D011372:Progestins / Q000627:therapeutic use*; D012306:Risk; D016896:Treatment Outcome
chemical_list: D011372:Progestins; D011374:Progesterone