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BJOG. 2019 Apr;126(5):556-567. doi: 10.1111/1471-0528.15566. Epub 2018 Dec 29.

Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: an updated systematic review and network meta-analysis.

Author information

1
Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.
2
Provincial Council for Maternal and Child Health, Toronto, ON, Canada.
3
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.

Abstract

BACKGROUND:

Recent progesterone trials call for an update of previous syntheses of interventions to prevent preterm birth.

OBJECTIVES:

To compare the relative effects of different types and routes of administration of progesterone, cerclage, and pessary at preventing preterm birth in at-risk women overall and in specific populations.

SEARCH STRATEGY:

We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL, and Web of Science up to 1 January 2018.

SELECTION CRITERIA:

We included randomised trials of progesterone, cerclage or pessary for preventing preterm birth in at-risk singleton pregnancies.

DATA COLLECTION AND ANALYSIS:

We used a piloted data extraction form and performed Bayesian random-effects network meta-analyses with 95% credibility intervals (CrI), as well as pairwise meta-analyses, rating the quality of the evidence using GRADE.

MAIN RESULTS:

We included 40 trials (11 311 women). In at-risk women overall, vaginal progesterone reduced preterm birth <34 (OR 0.43, 95% CrI 0.20-0.81) and <37 weeks (OR 0.51, 95% CrI 0.34-0.74), and neonatal death (OR 0.41, 95% CrI 0.20-0.83). In women with a previous preterm birth, vaginal progesterone reduced preterm birth <34 (OR 0.29, 95% CI 0.12-0.68) and <37 weeks (OR 0.43, 95% CrI 0.23-0.74), and 17α-hydroxyprogesterone caproate reduced preterm birth <37 weeks (OR 0.53, 95% CrI 0.27-0.95) and neonatal death (OR 0.39, 95% CI 0.16-0.95). In women with a short cervix (≤25 mm), vaginal progesterone reduced preterm birth <34 weeks (OR 0.45, 95% CI 0.24-0.84).

CONCLUSIONS:

Vaginal progesterone was the only intervention with consistent effectiveness for preventing preterm birth in singleton at-risk pregnancies overall and in those with a previous preterm birth.

TWEETABLE ABSTRACT:

In updated NMA, vaginal progesterone consistently reduced PTB in overall at-risk pregnancies and in women with previous PTB.

KEYWORDS:

Cervical cerclage; cervical pessary; network meta-analysis; preterm birth; progesterone; systematic review

PMID:
30480871
DOI:
10.1111/1471-0528.15566
[Indexed for MEDLINE]

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