PMID- 28067007
OWN - NLM
STAT- MEDLINE
DCOM- 20170828
LR  - 20170828
IS  - 1469-0705 (Electronic)
IS  - 0960-7692 (Linking)
VI  - 49
IP  - 3
DP  - 2017 Mar
TI  - Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality
      in women with a twin gestation and a short cervix: an updated meta-analysis of
      individual patient data.
PG  - 303-314
LID - 10.1002/uog.17397 [doi]
AB  - OBJECTIVE: To assess the efficacy of vaginal progesterone for the prevention of
      preterm birth and neonatal morbidity and mortality in asymptomatic women with a
      twin gestation and a sonographic short cervix (cervical length </= 25 mm) in the 
      mid-trimester. METHODS: This was an updated systematic review and meta-analysis
      of individual patient data (IPD) from randomized controlled trials comparing
      vaginal progesterone with placebo/no treatment in women with a twin gestation and
      a mid-trimester sonographic cervical length </= 25 mm. MEDLINE, EMBASE, POPLINE, 
      CINAHL and LILACS (all from inception to 31 December 2016), the Cochrane Central 
      Register of Controlled Trials, Research Registers of ongoing trials, Google
      Scholar, conference proceedings and reference lists of identified studies were
      searched. The primary outcome measure was preterm birth < 33 weeks' gestation.
      Two reviewers independently selected studies, assessed the risk of bias and
      extracted the data. Pooled relative risks (RRs) with 95% confidence intervals
      (CI) were calculated. RESULTS: IPD were available for 303 women (159 assigned to 
      vaginal progesterone and 144 assigned to placebo/no treatment) and their 606
      fetuses/infants from six randomized controlled trials. One study, which included 
      women with a cervical length between 20 and 25 mm, provided 74% of the total
      sample size of the IPD meta-analysis. Vaginal progesterone, compared with
      placebo/no treatment, was associated with a statistically significant reduction
      in the risk of preterm birth < 33 weeks' gestation (31.4% vs 43.1%; RR, 0.69 (95%
      CI, 0.51-0.93); moderate-quality evidence). Moreover, vaginal progesterone
      administration was associated with a significant decrease in the risk of preterm 
      birth < 35, < 34, < 32 and < 30 weeks' gestation (RRs ranging from 0.47 to 0.83),
      neonatal death (RR, 0.53 (95% CI, 0.35-0.81)), respiratory distress syndrome (RR,
      0.70 (95% CI, 0.56-0.89)), composite neonatal morbidity and mortality (RR, 0.61
      (95% CI, 0.34-0.98)), use of mechanical ventilation (RR, 0.54 (95% CI,
      0.36-0.81)) and birth weight < 1500 g (RR, 0.53 (95% CI, 0.35-0.80)) (all
      moderate-quality evidence). There were no significant differences in
      neurodevelopmental outcomes at 4-5 years of age between the vaginal progesterone 
      and placebo groups. CONCLUSION: Administration of vaginal progesterone to
      asymptomatic women with a twin gestation and a sonographic short cervix in the
      mid-trimester reduces the risk of preterm birth occurring at < 30 to < 35
      gestational weeks, neonatal mortality and some measures of neonatal morbidity,
      without any demonstrable deleterious effects on childhood neurodevelopment.
      Published 2017. This article is a U.S. Government work and is in the public
      domain in the USA.
CI  - Published 2017. This article is a U.S. Government work and is in the public
      domain in the USA.
FAU - Romero, R
AU  - Romero R
AD  - Perinatology Research Branch, Program for Perinatal Research and Obstetrics,
      Division of Intramural Research, 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.
AD  - Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI,
      USA.
AD  - Department of Epidemiology and Biostatistics, Michigan State University, East
      Lansing, MI, USA.
AD  - Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, 
      USA.
FAU - Conde-Agudelo, A
AU  - Conde-Agudelo A
AD  - Perinatology Research Branch, Program for Perinatal Research and Obstetrics,
      Division of Intramural Research, 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.
AD  - Department of Obstetrics and Gynecology, Wayne State University School of
      Medicine, Detroit, MI, USA.
FAU - El-Refaie, W
AU  - El-Refaie W
AD  - Department of Obstetrics and Gynecology, Mansoura University Hospitals, Mansoura 
      University, Mansoura, Egypt.
FAU - Rode, L
AU  - Rode L
AD  - Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen
      University Hospital, Rigshospitalet, Copenhagen, Denmark.
AD  - Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Herlev,
      Denmark.
FAU - Brizot, M L
AU  - Brizot ML
AD  - Department of Obstetrics and Gynecology, Sao Paulo University Medical School, Sao
      Paulo, Brazil.
FAU - Cetingoz, E
AU  - Cetingoz E
AD  - Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases
      Education and Research Hospital, Uskudar, Istanbul, Turkey.
FAU - Serra, V
AU  - Serra V
AD  - Maternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of
      Valencia, Valencia, Spain.
AD  - Department of Pediatrics, Obstetrics and Gynecology, University of Valencia,
      Valencia, Spain.
FAU - Da Fonseca, E
AU  - Da Fonseca E
AD  - Departamento de Obstetricia e Ginecologia, Hospital do Servidor Publico Estadual 
      'Francisco Morato de Oliveira' and School of Medicine, University of Sao Paulo,
      Sao Paulo, Brazil.
FAU - Abdelhafez, M S
AU  - Abdelhafez MS
AD  - Department of Obstetrics and Gynecology, Mansoura University Hospitals, Mansoura 
      University, Mansoura, Egypt.
FAU - Tabor, A
AU  - Tabor A
AD  - Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen
      University Hospital, Rigshospitalet, Copenhagen, Denmark.
AD  - University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark.
FAU - Perales, A
AU  - Perales A
AD  - Department of Pediatrics, Obstetrics and Gynecology, University of Valencia,
      Valencia, Spain.
AD  - Department of Obstetrics, University Hospital La Fe, Valencia, Spain.
FAU - Hassan, S S
AU  - Hassan SS
AD  - Perinatology Research Branch, Program for Perinatal Research and Obstetrics,
      Division of Intramural Research, 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.
AD  - Department of Obstetrics and Gynecology, Wayne State University School of
      Medicine, Detroit, MI, USA.
FAU - Nicolaides, K H
AU  - Nicolaides KH
AD  - Harris Birthright Research Centre for Fetal Medicine, King's College Hospital,
      London, UK.
LA  - eng
GR  - HHSN275201300006C/HD/NICHD NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PL  - England
TA  - Ultrasound Obstet Gynecol
JT  - Ultrasound in obstetrics & gynecology : the official journal of the International
      Society of Ultrasound in Obstetrics and Gynecology
JID - 9108340
RN  - 4G7DS2Q64Y (Progesterone)
SB  - IM
MH  - Administration, Intravaginal
MH  - Cervix Uteri/*drug effects/pathology
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infant Mortality/trends
MH  - Infant, Newborn
MH  - Maternal Death/*prevention & control
MH  - Maternal Mortality/trends
MH  - Perinatal Death/*prevention & control
MH  - Pregnancy
MH  - Pregnancy, Twin
MH  - Premature Birth/*prevention & control
MH  - Progesterone/*administration & dosage/pharmacology
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
PMC - PMC5396280
OTO - NOTNLM
OT  - cervical length
OT  - prematurity
OT  - preterm delivery
OT  - progestins
OT  - progestogens
OT  - transvaginal ultrasound
EDAT- 2017/01/10 06:00
MHDA- 2017/08/29 06:00
CRDT- 2017/01/10 06:00
PHST- 2016/12/03 00:00 [received]
PHST- 2016/12/23 00:00 [revised]
PHST- 2016/12/29 00:00 [accepted]
PHST- 2017/01/10 06:00 [pubmed]
PHST- 2017/08/29 06:00 [medline]
PHST- 2017/01/10 06:00 [entrez]
AID - 10.1002/uog.17397 [doi]
PST - ppublish
SO  - Ultrasound Obstet Gynecol. 2017 Mar;49(3):303-314. doi: 10.1002/uog.17397.