Vaginal Progesterone for the Prevention of Preterm Birth in Women with a Short Cervix: A Meta-Analysis

Abstract

Introduction: Preterm birth is the leading cause of neonatal mortality. A short cervical length detected on ultrasound is a strong predictor of preterm birth. This review evaluates the efficacy of vaginal progesterone in preventing preterm birth in this specific high-risk group.

Methods: We searched for placebo-controlled RCTs of vaginal progesterone in asymptomatic women with a singleton pregnancy and a mid-trimester cervical length of ≤25 mm. The primary outcome was the incidence of preterm birth before 34 weeks' gestation.

Results: The meta-analysis of 10 RCTs demonstrated that vaginal progesterone significantly reduced the risk of preterm birth before 34 weeks' gestation by approximately 40%. It also reduced the rates of respiratory distress syndrome and admission to the neonatal intensive care unit.

Discussion: Vaginal progesterone is an effective, non-invasive intervention for a well-defined high-risk population. Universal cervical length screening in the mid-trimester allows for the identification of candidates for this preventive therapy.

Conclusion: Vaginal progesterone significantly reduces the rate of preterm birth in women with a short cervix.