Progestogen maintenance therapy for prolongation of pregnancy after an episode of preterm labour: A systematic review and meta-analysis.
arrested preterm labour
meta-analysis
preterm birth
preterm labour
progesterone
progestogen
threatened preterm birth
threatened preterm labour
tocolysis
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:
10 2023
10 2023
Historique:
revised:
11
03
2023
received:
15
09
2022
accepted:
24
03
2023
medline:
4
9
2023
pubmed:
20
4
2023
entrez:
20
04
2023
Statut:
ppublish
Résumé
Evidence for progestogen maintenance therapy after an episode of preterm labour (PTL) is contradictory. To assess effectiveness of progestogen maintenance therapy after an episode of PTL. An electronic search in Central Cochrane, Ovid Embase, Ovid Medline and clinical trial databases was performed. Randomised controlled trials (RCT) investigating women between 16 Systematic review and meta-analysis were conducted. The primary outcome was latency time in days. Secondary neonatal and maternal outcomes are consistent with the core outcome set for preterm birth studies. Studies were extensively assessed for data trustworthiness (integrity) and risk of bias. Thirteen RCT (1722 women) were included. Progestogen maintenance therapy demonstrated a longer latency time of 4.32 days compared with controls (mean difference [MD] 4.32, 95% CI 0.40-8.24) and neonates were born with a higher birthweight (MD 124.25 g, 95% CI 8.99-239.51). No differences were found for other perinatal outcomes. However, when analysing studies with low risk of bias only (five RCT, 591 women), a significantly longer latency time could not be shown (MD 2.44 days; 95% CI -4.55 to 9.42). Progestogen maintenance therapy after PTL might have a modest effect on prolongation of latency time. When analysing low risk of bias studies only, this effect was not demonstrated. Validation through further research, preferably by an individual patient data meta-analysis is highly recommended.
Sections du résumé
BACKGROUND
Evidence for progestogen maintenance therapy after an episode of preterm labour (PTL) is contradictory.
OBJECTIVES
To assess effectiveness of progestogen maintenance therapy after an episode of PTL.
SEARCH STRATEGY
An electronic search in Central Cochrane, Ovid Embase, Ovid Medline and clinical trial databases was performed.
SELECTION CRITERIA
Randomised controlled trials (RCT) investigating women between 16
DATA COLLECTION AND ANALYSIS
Systematic review and meta-analysis were conducted. The primary outcome was latency time in days. Secondary neonatal and maternal outcomes are consistent with the core outcome set for preterm birth studies. Studies were extensively assessed for data trustworthiness (integrity) and risk of bias.
MAIN RESULTS
Thirteen RCT (1722 women) were included. Progestogen maintenance therapy demonstrated a longer latency time of 4.32 days compared with controls (mean difference [MD] 4.32, 95% CI 0.40-8.24) and neonates were born with a higher birthweight (MD 124.25 g, 95% CI 8.99-239.51). No differences were found for other perinatal outcomes. However, when analysing studies with low risk of bias only (five RCT, 591 women), a significantly longer latency time could not be shown (MD 2.44 days; 95% CI -4.55 to 9.42).
CONCLUSIONS
Progestogen maintenance therapy after PTL might have a modest effect on prolongation of latency time. When analysing low risk of bias studies only, this effect was not demonstrated. Validation through further research, preferably by an individual patient data meta-analysis is highly recommended.
Identifiants
pubmed: 37077041
doi: 10.1111/1471-0528.17499
doi:
Substances chimiques
Progestins
0
Tocolytic Agents
0
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1306-1316Informations de copyright
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
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