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Meta-Analysis
. 2016 Jan;132(1):11-6.
doi: 10.1016/j.ijgo.2015.06.058. Epub 2015 Oct 18.

A systematic review and meta-analysis of progestogen use for maintenance tocolysis after preterm labor in women with intact membranes

Ahizechukwu C Eke  1 , Tina Chalaan  2 , Ghadear Shukr  2 , George U Eleje  3 , Charles I Okafor  3
Affiliations
Meta-Analysis

A systematic review and meta-analysis of progestogen use for maintenance tocolysis after preterm labor in women with intact membranes

Ahizechukwu C Eke et al. Int J Gynaecol Obstet. 2016 Jan.

Abstract

Background: The use of progestogens for maintenance tocolysis remains controversial, with randomized controlled trials having conflicting results on their efficacy.

Objectives: To evaluate the use of progestational agents for maintenance tocolysis after preterm labor in a systematic review of randomized controlled trials.

Search strategy: Electronic databases were searched for reports published before December 2014. Keywords included "tocolysis," "progesterone," "preterm labor," "17-alpha-hydroxyprogesterone," and "vaginal progesterone."

Selection criteria: Only randomized controlled trials involving progestational agents for maintenance tocolysis were included.

Data collection and analysis: Outcomes were analyzed on an intent-to-treat basis and meta-analysis was performed where appropriate. Relative risks and mean differences with 95% confidence intervals were calculated.

Main results: Four studies (362 women) were included. There were no significant differences between progestational agents and placebo/no treatment in terms of delivery before 34weeks or before 37weeks of pregnancy, time from randomization to delivery, and respiratory distress syndrome. Progestogens were associated with an increase in the neonatal birth weight (mean difference 203.32g, 95% confidence interval 110.85-295.80; P=0.032).

Conclusions: The current evidence does not support the routine use of progestational agents for maintenance tocolysis after an episode of preterm labor.

Keywords: 17α-hydroxyprogesterone; Preterm labor; Tocolysis; Vaginal progesterone.

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Conflict of interest statement

Conflict of interest

The authors have no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Study flow diagram.
Fig. 2.
Fig. 2.
Risk of bias of individual studies included in the systematic review.
Fig. 3.
Fig. 3.
Effect of the use of progestational agents versus no treatment or placebo after an episode of preterm labor on the rate of preterm birth before 34 weeks of pregnancy. Abbreviations: M-H, Mantel–Haenszel test; CI, confidence interval; df, degree of freedom.
Fig. 4.
Fig. 4.
Effect of the use of progestational agents versus no treatment or placebo after an episode of preterm labor on the time from randomization until birth (latency period). Abbreviations: SD, standard deviation; IV, independent variable; CI, confidence interval; df, degree of freedom.
See this image and copyright information in PMC

References

    1. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008;371(9606):75–84. - PMC - PubMed
    1. Martin JA, Hamilton BE, Osterman MJK, Curtin SC, Mathews TJ. Births: Final Data for 2013. Natl Vital Stat Rep 2015;64(1):1–68. - PubMed
    1. Callaghan WM, MacDorman MF, Rasmussen SA, Qin C, Lackritz EM. The contribution of preterm birth to infant mortality rates in the United States. Pediatrics 2006;118(4):1566–73. - PubMed
    1. Meis PJ, Klebanoff M, Thom E, Dombrowski MP, Sibai B, Moawad AH, et al. , National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 2003;348(24):2379–85. - PubMed
    1. da Fonseca EB, Bittar RE, Carvalho MH, Zugaib M. 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(2):419–24. - PubMed