Efficacy of Vaginal Progesterone for Maintenance Tocolysis: A Recent Trend in the Management of Arrested Preterm Labour
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- Category: Vol. 77, June 2009
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Efficacy of Vaginal Progesterone for Maintenance Tocolysis: A Recent Trend in the Management of Arrested Preterm Labour,EMAN Z. EL-ABIDIN, MARYAM MAHMOOD, HAMSA RASHWAN and AMAL HANAFY
Abstract
Background: Preterm birth is a leading cause of perinatal morbidity and mortality worldwide. Women with preterm labour that is halted with tocolytic therapy are at increased risk of recurrence. However, there is insufficient evidence to justify the use of maintenance tocolytic therapy after successful arrest of preterm labour.
Aim: The objective of this study was to determine whether supplementation of vaginal progesterone, after inhibition of preterm labour, is associated with prolongation of gestation and subsequent improvement in neonatal outcome.
Setting: OB/GYN casuality ward of Kasr Al Aini Teaching Hospital in Cairo.
Methods: This trial included 40 women presenting with symptoms of threatened preterm labour, whom after arrest of uterine activity were then randomized to progesterone therapy or no treatment. Treatment group received progesterone suppository (200mg) twice daily until delivery and control group received no treatment. The primary outcome was latency period and recurrent preterm labour. The secondary outcome was birth weight and neonatal morbidity.
Results: The progesterone group had significantly longer mean latency until delivery (8.3±1.9 weeks Vs 5.0±1.2 weeks) (mean ± standard deviation); less recurrent preterm labour 3 (15%) Vs 9 (45%) and higher birth weight (2.6±0.4kg Vs 1.9±0.2kg, p=<0.001). The overall neonatal morbidity was not significantly different between the two groups.
Conclusion: The use of vaginal progesterone suppository after successful parenteral tocolysis is associated with a longer latency preceding delivery and a lower incidence of recurrent preterm labour. However, progesterone therapy failed to lead to a significant improvement in the overall neonatal outcome.