Guideline No. 398: Progesterone for Prevention of Spontaneous Preterm Birth

Abstract

Objectives: To assess the benefits and risks of progesterone therapy for women at increased risk of spontaneous preterm birth (SPB) and to make recommendations for the use of progesterone to reduce the risk of SPB and improve postnatal outcomes.

Options: To administer or withhold progesterone therapy for women deemed to be at high risk of SPB.

Outcomes: Preterm birth, neonatal morbidity and mortality, and postnatal outcomes including neurodevelopmental outcomes.

Intended users: Maternity care providers, including midwives, family physicians, and obstetricians.

Target population: Pregnant women at increased risk of SPB.

Evidence: Medline, PubMed, EMBASE, and the Cochrane Library were searched from inception to October 2018 for medical subject heading (MeSH) terms and keywords related to pregnancy, preterm birth, previous preterm birth, short cervix, uterine anomalies, cervical conization, neonatal morbidity and mortality, and postnatal outcomes. This document represents an abstraction of the evidence rather than a methodological review.

Validation methods: This guideline was reviewed by the Maternal-Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and approved by the SOGC Board of Directors.

Benefits, harms, and/or costs: Therapy with progesterone significantly reduces the risk of SPB in a subpopulation of women at increased risk. Although this therapy entails a cost to the woman in addition to the discomfort associated with its use, no other adverse effects to the mother or the baby have been identified.

Summary statements (grade ratings in parentheses): RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

Keywords: administration, intravaginal; cervical length measurement; obstetric labor, premature; pregnancy complications; pregnancy outcome; premature birth; progesterone.