Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: an updated systematic review and network meta-analysis.
17 alpha-Hydroxyprogesterone Caproate
/ administration & dosage
Administration, Intravaginal
Administration, Oral
Cerclage, Cervical
/ statistics & numerical data
Cervical Length Measurement
Cervix Uteri
/ pathology
Female
Humans
Infant, Newborn
Network Meta-Analysis
Perinatal Death
/ prevention & control
Pessaries
/ statistics & numerical data
Pregnancy
Pregnancy, High-Risk
Premature Birth
/ pathology
Progesterone
/ administration & dosage
Randomized Controlled Trials as Topic
Treatment Outcome
Cervical cerclage
cervical pessary
network meta-analysis
preterm birth
progesterone
systematic review
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
accepted:
12
11
2018
pubmed:
28
11
2018
medline:
22
3
2019
entrez:
28
11
2018
Statut:
ppublish
Résumé
Recent progesterone trials call for an update of previous syntheses of interventions to prevent preterm birth. To compare the relative effects of different types and routes of administration of progesterone, cerclage, and pessary at preventing preterm birth in at-risk women overall and in specific populations. We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL, and Web of Science up to 1 January 2018. We included randomised trials of progesterone, cerclage or pessary for preventing preterm birth in at-risk singleton pregnancies. We used a piloted data extraction form and performed Bayesian random-effects network meta-analyses with 95% credibility intervals (CrI), as well as pairwise meta-analyses, rating the quality of the evidence using GRADE. We included 40 trials (11 311 women). In at-risk women overall, vaginal progesterone reduced preterm birth <34 (OR 0.43, 95% CrI 0.20-0.81) and <37 weeks (OR 0.51, 95% CrI 0.34-0.74), and neonatal death (OR 0.41, 95% CrI 0.20-0.83). In women with a previous preterm birth, vaginal progesterone reduced preterm birth <34 (OR 0.29, 95% CI 0.12-0.68) and <37 weeks (OR 0.43, 95% CrI 0.23-0.74), and 17α-hydroxyprogesterone caproate reduced preterm birth <37 weeks (OR 0.53, 95% CrI 0.27-0.95) and neonatal death (OR 0.39, 95% CI 0.16-0.95). In women with a short cervix (≤25 mm), vaginal progesterone reduced preterm birth <34 weeks (OR 0.45, 95% CI 0.24-0.84). Vaginal progesterone was the only intervention with consistent effectiveness for preventing preterm birth in singleton at-risk pregnancies overall and in those with a previous preterm birth. In updated NMA, vaginal progesterone consistently reduced PTB in overall at-risk pregnancies and in women with previous PTB.
Sections du résumé
BACKGROUND
BACKGROUND
Recent progesterone trials call for an update of previous syntheses of interventions to prevent preterm birth.
OBJECTIVES
OBJECTIVE
To compare the relative effects of different types and routes of administration of progesterone, cerclage, and pessary at preventing preterm birth in at-risk women overall and in specific populations.
SEARCH STRATEGY
METHODS
We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL, and Web of Science up to 1 January 2018.
SELECTION CRITERIA
METHODS
We included randomised trials of progesterone, cerclage or pessary for preventing preterm birth in at-risk singleton pregnancies.
DATA COLLECTION AND ANALYSIS
METHODS
We used a piloted data extraction form and performed Bayesian random-effects network meta-analyses with 95% credibility intervals (CrI), as well as pairwise meta-analyses, rating the quality of the evidence using GRADE.
MAIN RESULTS
RESULTS
We included 40 trials (11 311 women). In at-risk women overall, vaginal progesterone reduced preterm birth <34 (OR 0.43, 95% CrI 0.20-0.81) and <37 weeks (OR 0.51, 95% CrI 0.34-0.74), and neonatal death (OR 0.41, 95% CrI 0.20-0.83). In women with a previous preterm birth, vaginal progesterone reduced preterm birth <34 (OR 0.29, 95% CI 0.12-0.68) and <37 weeks (OR 0.43, 95% CrI 0.23-0.74), and 17α-hydroxyprogesterone caproate reduced preterm birth <37 weeks (OR 0.53, 95% CrI 0.27-0.95) and neonatal death (OR 0.39, 95% CI 0.16-0.95). In women with a short cervix (≤25 mm), vaginal progesterone reduced preterm birth <34 weeks (OR 0.45, 95% CI 0.24-0.84).
CONCLUSIONS
CONCLUSIONS
Vaginal progesterone was the only intervention with consistent effectiveness for preventing preterm birth in singleton at-risk pregnancies overall and in those with a previous preterm birth.
TWEETABLE ABSTRACT
CONCLUSIONS
In updated NMA, vaginal progesterone consistently reduced PTB in overall at-risk pregnancies and in women with previous PTB.
Identifiants
pubmed: 30480871
doi: 10.1111/1471-0528.15566
doi:
Substances chimiques
17 alpha-Hydroxyprogesterone Caproate
276F2O42F5
Progesterone
4G7DS2Q64Y
Banques de données
GENBANK
['CRD42015016166', 'ed2015']
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
556-567Subventions
Organisme : Canadian Institutes of Health Research (CIHR) Tier II Canada Research Chair
ID : 950-229920
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2018 Royal College of Obstetricians and Gynaecologists.