For years, the prescription of progesterone in the event of a threat of premature birth was normal, despite the absence of any demonstration of a fetal or neonatal benefit in this situation. The description of an increased risk of cholestasis of pregnancy during this treatment was terminated this requirement.
Recently, several randomized double-blind study showed a benefit of progesterone in preventing the risk of recurrence of prematurity. This review includes the physiopathological justification of the use of progesterone, discusses the biases and limitations of earlier studies and describes the two recent randomized trials which could use progesterone "fashionable."
The data from these trials do not seem convincing that the preventive use of 17 alpha-hydroxyprogesterone injection started early during pregnancy in women with a history of prematurity. This requirement could be integrated in a more comprehensive preventive strategy in which the cervical cerclage and preventive treatment of bacterial vaginosis may also have their place.
[...] Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: A randomized placebo-controlled double-blind study. Am J Obstet Gynecol 2003; 188: 419- Meis PJ, Klebanoff Thom Dombrowski MP, Sibai Moawad AH et al. Prevention of recurrent preterm delivey by 17 alpha- hydroxyprogesterone caproate. N Engl J Med 2003; 348: 2379- AI Csapo. Progesterone block. Am J Anat 1956; 98: 273- Garfield RE, Dannan MS, Daniel EE. Gap-junction formation in myometrium: Control by estrogens, progesterone, and prostaglandins. [...]
[...] Effects of progesterone on prostaglandin E2 - induced changes in glycosaminoglycan production by human cervical fibroblasts in culture. Mol Hum Reprod 2000; 661- Erny Pigne Prouvost Gamerre Malet Serment H et al. The effects of oral administration of progesterone for premature labor. Am J Obstet Gynecol 1986; 154: 525- Mitchell Cruickshank McLain, Challis JRG. Local modulation of progesterone production in human fetal membranes. J Clin Endocrinol Metab 1982; 55: 1237- Frydman Lelaidier Baton-Saint-Mleux Fernandez Vial Bourget P. Labor induction in women at term with mifepristone (RU 486) : a double-blind, randomized, placebo-controlled study. [...]
[...] The results show, according to the authors, a significant reduction in premature births among women treated compared to those receiving placebo ( against respectively, p = 0.03 ) and especially a reduction in deliveries before 34 SA ( against respectively, p = 0.002 However, this study raises several critical methodological analysis of the results that may be to reduce the importance of the findings: a number of exclusions have been performed in the placebo group and 9 in the progesterone group) during the analysis for the following reasons: patients lost of view, premature birth by medical decision, allergy product and premature rupture of membranes before term; These exclusions mean that an analysis of the results is not made "intent to treat". [...]
[...] These two studies have evaluated the use of progesterone in prevention of recurrence of preterm birth or late miscarriage, and not as a treatment tocolytique. This distinction is important because no study currently allows to extrapolate on the use of progesterone in preterm labor is already installed. Several methods have received renewed interest in recent years in the prevention of recurrence of preterm birth or late miscarriage in women at high risk: strapping preventive treatment of bacterial vaginosis and administration of progesterone. [...]
[...] In the absence of evidence about the real risk of cholestasis in women receiving this treatment, regular clinical supervision and transaminases should be proposed in women who receive this treatment. Information for patients known to be treated should also mention this possibility and the possibility to have in this case to stop the treatment. Strategies for preventing recurrent preterm delivery The recent call-to-date the use of progesterone in prevention of recurrence of prematurity. Although data from the study of Meis et al. are particularly encouraging this requirement can probably be considered as the only remedy for a history of preterm delivery (and also late spontaneous abortion). [...]
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