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Vaginal progesterone and risk for preterm birth (March 2016)

 Progesterone (intramuscular or vaginal) is administered to pregnant women with a history of preterm birth or a short cervix in the current pregnancy to reduce the risk of preterm birth. However, a recent large trial did not observe a benefit for vaginal progesterone. In the OPPTIMUM trial, over 1200 women at high risk for preterm birth by various criteria were randomly assigned to receive either vaginal progesterone or a placebo daily, beginning at 22 to 24 weeks of gestation and ending at 34 weeks [7]. Progesterone supplementation did not reduce any of the primary study outcomes: fetal death or birth before 34 weeks; neonatal death, brain injury, or bronchopulmonary dysplasia; cognitive score at two years of age.

We continue to suggest hydroxyprogesterone caproate injections for women with a previous preterm birth because this drug was effective in previous trials and not evaluated by this trial. We continue to suggest vaginal progesterone for women with a short cervix since this population was not the focus of this trial. An updated meta-analysis addressing vaginal progesterone supplementation for women with a short cervix that includes data from this new trial would be helpful. (See "Progesterone supplementation to reduce the risk of spontaneous preterm birth", section on 'OPPTIMUM (progesterone capsules vaginally)'.)



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