A systematic review and meta-analysis of progestogen use for maintenance tocolysis after preterm labor in women with intact membranes.
BACKGROUND
The use of progestogens for maintenance tocolysis remains controversial, with randomized controlled trials having conflicting results on their efficacy.


OBJECTIVE
To evaluate the use of progestational agents for maintenance tocolysis after preterm labor in a systematic review of randomized controlled trials.


METHODS
Electronic databases were searched for reports published before December 2014. Keywords included "tocolysis," "progesterone," "preterm labor," "17-alpha-hydroxyprogesterone," and "vaginal progesterone."


METHODS
Only randomized controlled trials involving progestational agents for maintenance tocolysis were included.


METHODS
Outcomes were analyzed on an intent-to-treat basis and meta-analysis was performed where appropriate. Relative risks and mean differences with 95% confidence intervals were calculated.


RESULTS
Four studies (362 women) were included. There were no significant differences between progestational agents and placebo/no treatment in terms of delivery before 34weeks or before 37weeks of pregnancy, time from randomization to delivery, and respiratory distress syndrome. Progestogens were associated with an increase in the neonatal birth weight (mean difference 203.32g, 95% confidence interval 110.85-295.80; P=0.032).


CONCLUSIONS
The current evidence does not support the routine use of progestational agents for maintenance tocolysis after an episode of preterm labor.
Department of Obstetrics and Gynecology, Michigan State University/Sparrow Hospital, Lansing, MI, USA. Electronic address: ahizeeke2nd@yahoo.ca.
Ahizechukwu C
AC
Eke
College of Human Medicine, Michigan State University, Lansing, MI, USA.
Tina
T
Chalaan
College of Human Medicine, Michigan State University, Lansing, MI, USA.
Ghadear
G
Shukr
Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
George U
GU
Eleje
Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
Charles I
CI
Okafor
D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000188:drug therapy / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011372:Progestins / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention / Q000379:methods*; D015145:Tocolysis / Q000379:methods*; D015149:Tocolytic Agents / Q000627:therapeutic use*
D011372:Progestins; D015149:Tocolytic Agents
17α-hydroxyprogesterone; Preterm labor; Tocolysis; Vaginal progesterone