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Prenatal administration of progesterone to prevent preterm birth in women considered to be at risk of having their baby early

Babies who are born before 37 weeks, and particularly those born before 34 weeks, are at greater risk of having problems at birth and complications in infancy. Infants who are born preterm are at greater risk of dying in their first year of life, and of those infants who survive, there is an increased risk of repeated admission to hospital and adverse outcomes including cerebral palsy and long‐term disability. Progesterone is a hormone that reduces contractions of the uterus and has an important role in maintaining pregnancy and is suggested for the prevention of preterm labour. Maternal side‐effects from progesterone therapy include headache, breast tenderness, nausea, cough and local irritation if administered intramuscularly. At present, there is little information available regarding the optimal dose of progesterone, mode of administration, gestation to commence therapy, or duration of therapy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

The effect of hormonal treatment on advanced or recurrent endometrial cancer

Endometrial cancer is cancer arising from the lining of the womb. Most women with endometrial cancer are diagnosed when their tumour is still confined to the body of the womb. However, about 10% of women with endometrial cancer are diagnosed when the disease is already at an advanced stage. The latter group of patients tend to have much poorer survival.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Technique modification for reducing the risks from amniocentesis or chorionic villus sampling

Currently, many technical aspects of how amniocentesis and chorionic villus sampling (CVS) are carried out are left to the operator's personal preference. We compare the safety and accuracy of various modifications and included five randomised studies with 1049 women. For amniocentesis, studies evaluated drugs that relax the uterus (tocolytics), progesterone prophylaxis, or compared the difference in safety for different puncture sites. For CVS, one study included tocolysis prior to procedure and the other evaluated the role of continuous vacuum for aspiration of the placental tissue. None of these modifications had clinically important effects on procedure safety. Overall, we found no evidence of sufficient quality to change current clinical practice. Studies of high quality with adequate safety outcomes and power to detect important clinical differences would be clearly welcome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

No evidence to support use of adjuvant progestagens to prevent recurrence of endometrial cancer after surgery

Endometrial (womb) cancer is the most common genital tract cancer in developed countries. Progestagen (a hormone) therapy is sometimes used following initial surgery to reduce the risk of recurrence. However, progestagens have been found to reduce one of the protective factors against heart disease and may also make tumours more resistant to radiotherapy. This review found no evidence to support the use of progestagen as an addition to surgery for newly diagnosed endometrial cancer. Progestagen can, however, prevent or delay recurrence of cancer in some patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Progestational agents to prevent preterm birth: a meta-analysis of randomized controlled trials

This well-conducted review assessed progestational agents for the prevention of pre-term birth. The authors concluded that progestational agents can reduce the incidence of pre-term birth and low birth weight newborns. No difference was found in hospitalisation for threatened pre-term birth or perinatal mortality. Although the exact quality of the included studies was unknown, the conclusion is likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Cervical stitch for preventing preterm births in singleton pregnancy

Cervical cerclage is a surgical procedure that is carried out during pregnancy to position a stitch (suture) around the neck of the womb (cervix). The purpose is to give mechanical support to the cervix and so reduce the risk of preterm birth. During normal pregnancy the neck of the cervix stays tightly closed, allowing the pregnancy to reach full term. Towards the end of pregnancy the cervix starts to shorten and progressively becomes softer preparing for normal labour and delivery. Sometimes, the cervix starts to shorten and dilates too early, causing either late miscarriage or preterm birth.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Preterm Labour and Birth

This guideline reviews the evidence for the care of women who present with signs and symptoms of preterm labour and those who are scheduled to have a preterm birth. It also reviews how preterm birth can be optimally diagnosed in symptomatic women, given that many women thought to be in preterm labour when clinically assessed will not deliver preterm. Optimal diagnosis can facilitate transfer to a place where appropriate neonatal intensive care can be provided, a strategy known to improve rates of survival for the baby. Additional areas that will be covered by the guidance (such as information needs for women who presents with signs and symptoms of preterm labour) are outlined in the guideline scope.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: November 2015
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Omega-3 Fatty Acids and Maternal and Child Health: An Updated Systematic Review

To update a prior systematic review on the effects of omega-3 fatty acids (n-3 FA) on maternal and child health and to assess the evidence for their effects on, and associations with, additional outcomes.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: October 2016
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Endometrial Cancer Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of endometrial cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: February 2, 2017

Fertility: Assessment and Treatment for People with Fertility Problems

This guideline offers best practice advice on assisting people of reproductive age who have problems conceiving.

NICE Clinical Guidelines - National Collaborating Centre for Women’s and Children’s Health (UK).

Version: February 2013
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Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage

The guideline covers diagnosis of early pregnancy loss, including the use of ultrasound scanning and biochemical testing. Investigations incur costs and the use of serial measurements may delay decision making. The guideline includes guidance on when senior and/or specialist advice should be sought in order to avoid errors and unnecessary delay.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: December 2012
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Progesterone for the prevention of preterm birth among women at increased risk: a systematic review and meta-analysis of randomized controlled trials

This review evaluated the effects of progestational agents on the prevention of pre-term birth. The authors concluded that treatment initiated in the second trimester of pregnancy reduces the risks of pre-term delivery, but the effect on other clinical outcomes is uncertain. Although the conclusions are likely to be reliable, limited evidence means that their wider applicability is unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Progestogens for preterm birth prevention: a systematic review and meta-analysis

The review concluded that progestogens prevented preterm birth in singleton pregnancies for women with prior preterm birth, but not multiple gestations; other indications had insufficient evidence to reach conclusions. Given the possibility of missed studies, a mostly poor quality evidence base and considerable clinical variation, the authors' cautious conclusions should be considered tentative.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Transvaginal ultrasonographic measurement of cervical length as a predictor of preterm birth: a systematic review with meta-analysis

The advent of effective interventions to prevent preterm delivery such as 17 hydroxyprogesterone and cerclage serve as an impetus to determine whether routine second trimester transvaginal cervical length screening can identify which women would benefit from these therapies. A systematic review was conducted, 957 abstracts were screened, 234 articles underwent full-text review, and 23 studies were included in the final analysis including 26,792 women. Data from relevant studies were pooled to produce summary estimates of sensitivity, specificity, and likelihood ratios using a random effects model. The ideal criteria of transvaginal cervical length measurements to predict preterm delivery are discussed.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): a randomised, double-blind, placebo-controlled study and meta-analysis

This review assessed the effectiveness of progesterone on the occurrence of delivery or intrauterine death before 34 weeks of gestation in women with twin pregnancy, concluding that progesterone was not effective. Despite the relatively limited literature search and poor reporting of some aspects of the review, the authors' conclusions appear to reflect the evidence and are probably reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Progesterone for the prevention of preterm birth: a critical evaluation of evidence

The authors concluded that progestational agents should be given to women at high risk of pre-term delivery. These conclusions appear to reflect the data presented, but poor reporting of review methods and a lack of detail about the participants and interventions mean it is not possible to assess the reliability of these conclusions and their general applicability.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

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