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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, Joachim W.

Editorial Board Member: / Bancalari, Eduardo / Milner, Anne / Genc, Mehmet R. / Chervenak, Frank A. / Chappelle, Joseph / Bergmann, Renate L. / Bernardes, J.F. / Bevilacqua, G. / Blickstein, Isaac / Cabero Roura, Luis / Carbonell-Estrany, Xavier / Carrera, Jose M. / D`Addario, Vincenzo / D'Alton, MD, Mary E. / Dimitrou, G. / Grunebaum, Amos / Hentschel, Roland / Köpcke, W. / Kawabata, Ichiro / Keirse, Marc J.N.C. / Kurjak M.D., Asim / Lee, Ben H. / Levene, Malcolm / Lockwood, Charles J. / Marsal, Karel / Makatsariya, Alexander / Nishida, Hiroshi / Papp, Zoltán / Pejaver, Ranjan Kumar / Pooh, Ritsuko K. / Romero, Roberto / Saugstad, Ola D. / Schenker, Joseph G. / Sen, Cihat / Seri, Istvan / Vetter, Klaus / Winn, Hung N. / Young, Bruce K. / Zimmermann, Roland

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1619-3997
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In This Section
Volume 41, Issue 1 (Jan 2013)

Issues

A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix

Roberto Romero
  • Corresponding author
  • Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, MD, and Detroit, MI, USA
  • Roberto Romero has contributed to this work as part of his official duties as an employee of the US federal government.
  • Email:
/ Lami Yeo
  • Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, MD, and Detroit, MI, USA
  • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
/ Jezid Miranda
  • Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, MD, and Detroit, MI, USA
/ Sonia S. Hassan
  • Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, MD, and Detroit, MI, USA
  • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
/ Agustin Conde-Agudelo
  • Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, MD, and Detroit, MI, USA
/ Tinnakorn Chaiworapongsa
  • Perinatology Research Branch, NICHD, NIH, DHHS, Bethesda, MD, and Detroit, MI, USA
  • Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
Published Online: 2013-01-05 | DOI: https://doi.org/10.1515/jpm-2012-0272

Abstract

Preterm birth is the leading cause of perinatal morbidity and mortality worldwide, and is the most important challenge to modern obstetrics. A major obstacle has been that preterm birth is treated (implicitly or explicitly) as a single condition. Two thirds of preterm births occur after the spontaneous onset of labor, and the remaining one third after “indicated” preterm birth; however, the causes of spontaneous preterm labor and “indicated” preterm birth are different. Spontaneous preterm birth is a syndrome caused by multiple etiologies, one of which is a decline in progesterone action, which induces cervical ripening. A sonographic short cervix (identified in the midtrimester) is a powerful predictor of spontaneous preterm delivery. Randomized clinical trials and individual patient meta-analyses have shown that vaginal progesterone reduces the rate of preterm delivery at <33 weeks of gestation by 44%, along with the rate of admission to the neonatal intensive care unit, respiratory distress syndrome, requirement for mechanical ventilation, and composite neonatal morbidity/mortality score. There is no evidence that 17-α-hydroxyprogesterone caproate can reduce the rate of preterm delivery in women with a short cervix, and therefore, the compound of choice is natural progesterone (not the synthetic progestin). Routine assessment of the risk of preterm birth with cervical ultrasound coupled with vaginal progesterone for women with a short cervix is cost-effective, and the implementation of such a policy is urgently needed. Vaginal progesterone is as effective as cervical cerclage in reducing the rate of preterm delivery in women with a singleton gestation, history of preterm birth, and a short cervix (<25 mm).

Keywords: Cervical cerclage; cost-effective analysis; infant mortality; pessary; pregnancy; prematurity; respiratory distress syndrome; 17-α-hydroxyprogesterone caproate (17OHP-C or 17P)

About the article

Corresponding author: Roberto Romero, MD Perinatology Research Branch NICHD/NIH/DHHS Hutzel Women’s Hospital 3990 John R. Box 4 Detroit, MI 48201 USA Tel.: +1-313-993-2700 Fax: +1-313-993-2694


Received: 2012-06-12

Revised: 2012-11-20

Accepted: 2012-12-07

Published Online: 2013-01-05

Published in Print: 2013-01-01



Citation Information: Journal of Perinatal Medicine, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2012-0272. Export Citation

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