The effectiveness of vaginal progesterone in reducing preterm birth in high-risk patients diagnosed with short cervical length after 24 weeks: A retrospective cohort study

Danielle Luxenbourg; Shay Porat; Roberto Romero; Dror Raif Nesher; Rani Haj Yahya; Yishai Sompolinsky; Hila Hochler; Yossef Ezra; Doron Kabiri

doi:10.3389/fmed.2023.1130942

The effectiveness of vaginal progesterone in reducing preterm birth in high-risk patients diagnosed with short cervical length after 24 weeks: A retrospective cohort study

Danielle Luxenbourg, Shay Porat, Roberto Romero, Dror Raif Nesher, Rani Haj Yahya, Yishai Sompolinsky, Hila Hochler, Yossef Ezra^*, Doron Kabiri^*

^*Corresponding author for this work

Faculty of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: To assess the impact of progesterone treatment on maternal and neonatal outcomes in women with a history of preterm birth and short cervical length diagnosed after 24 weeks of gestation. Methods: A retrospective cohort study included women with a history of preterm birth and a transvaginal sonographic cervical length measurement of ≤ 25 mm, diagnosed between 24⁺⁰ and 33⁺⁶ weeks of gestation. Exclusion criteria included prior progesterone treatment, cervical cerclage, or pessary. The study population was divided into the progesterone treatment group and the non-treatment group. Results: The study included 104 women, with 46.2% (48/104) receiving progesterone treatment and 53.8% (56/104) not receiving treatment. The rate of spontaneous preterm birth before 37 weeks of gestation was 43% (24/56) in the non-treatment group and 31% (15/48) in the progesterone treatment group (P = 0.14); the rate of spontaneous preterm birth before 34 weeks was 7% (4/56) in the non-treatment group and 0% (0/48) in the progesterone treatment group (P = 0.05). Progesterone treatment was associated with a significant decrease in neonatal intensive care unit admissions (OR 0.20, 95% CI 0.05–0.74) and in the neonatal hospitalization period (mean difference in days 2.43, 95% CI 0.44–4.42). The risk of recurrent spontaneous preterm birth was highest (71%) among women with two or more previous preterm deliveries who did not receive progesterone treatment, and lowest (24%) among women with one previous preterm delivery who received progesterone treatment. Conclusion: Progesterone treatment was associated with a reduction in rates of spontaneous preterm birth before 34 weeks of gestation, neonatal intensive care unit admission, and neonatal length of stay in high-risk patients, even when initiated after 24 weeks of gestation.

Original language	American English
Article number	1130942
Journal	Frontiers in Medicine
Volume	10
DOIs	https://doi.org/10.3389/fmed.2023.1130942
State	Published - 2023

Bibliographical note

Funding Information:
This research was supported, in part, by the Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS); and, in part, with Federal funds from NICHD/NIH/DHHS under Contract No. HHSN275201300006C. RR has contributed to this work as part of his official duties as an employee of the United States Federal Government. Hadassah Hebrew University has a Federal Wide Assurance with the Office for Human Research Protections (OHRP) of the Department of Health and Human Services (DHHS) of the United States. The funder had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication.

Funding Information:
This research was supported, in part, by the Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS); and, in part, with Federal funds from NICHD/NIH/DHHS under Contract No. HHSN275201300006C. RR has contributed to this work as part of his official duties as an employee of the United States Federal Government. Hadassah Hebrew University has a Federal Wide Assurance with the Office for Human Research Protections (OHRP) of the Department of Health and Human Services (DHHS) of the United States. The funder had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication.

Publisher Copyright:
Copyright © 2023 Luxenbourg, Porat, Romero, Raif Nesher, Haj Yahya, Sompolinsky, Hochler, Ezra and Kabiri.

Keywords

admission to neonatal intensive care unit
prematurity
preterm delivery
preterm labor
progesterone
progestogen
short cervix

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10.3389/fmed.2023.1130942

Cite this

Luxenbourg, D., Porat, S., Romero, R., Raif Nesher, D., Haj Yahya, R., Sompolinsky, Y., Hochler, H., Ezra, Y., & Kabiri, D. (2023). The effectiveness of vaginal progesterone in reducing preterm birth in high-risk patients diagnosed with short cervical length after 24 weeks: A retrospective cohort study. Frontiers in Medicine, 10, Article 1130942. https://doi.org/10.3389/fmed.2023.1130942

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title = "The effectiveness of vaginal progesterone in reducing preterm birth in high-risk patients diagnosed with short cervical length after 24 weeks: A retrospective cohort study",

abstract = "Objective: To assess the impact of progesterone treatment on maternal and neonatal outcomes in women with a history of preterm birth and short cervical length diagnosed after 24 weeks of gestation. Methods: A retrospective cohort study included women with a history of preterm birth and a transvaginal sonographic cervical length measurement of ≤ 25 mm, diagnosed between 24+0 and 33+6 weeks of gestation. Exclusion criteria included prior progesterone treatment, cervical cerclage, or pessary. The study population was divided into the progesterone treatment group and the non-treatment group. Results: The study included 104 women, with 46.2% (48/104) receiving progesterone treatment and 53.8% (56/104) not receiving treatment. The rate of spontaneous preterm birth before 37 weeks of gestation was 43% (24/56) in the non-treatment group and 31% (15/48) in the progesterone treatment group (P = 0.14); the rate of spontaneous preterm birth before 34 weeks was 7% (4/56) in the non-treatment group and 0% (0/48) in the progesterone treatment group (P = 0.05). Progesterone treatment was associated with a significant decrease in neonatal intensive care unit admissions (OR 0.20, 95% CI 0.05–0.74) and in the neonatal hospitalization period (mean difference in days 2.43, 95% CI 0.44–4.42). The risk of recurrent spontaneous preterm birth was highest (71%) among women with two or more previous preterm deliveries who did not receive progesterone treatment, and lowest (24%) among women with one previous preterm delivery who received progesterone treatment. Conclusion: Progesterone treatment was associated with a reduction in rates of spontaneous preterm birth before 34 weeks of gestation, neonatal intensive care unit admission, and neonatal length of stay in high-risk patients, even when initiated after 24 weeks of gestation.",

keywords = "admission to neonatal intensive care unit, prematurity, preterm delivery, preterm labor, progesterone, progestogen, short cervix",

author = "Danielle Luxenbourg and Shay Porat and Roberto Romero and {Raif Nesher}, Dror and {Haj Yahya}, Rani and Yishai Sompolinsky and Hila Hochler and Yossef Ezra and Doron Kabiri",

note = "Funding Information: This research was supported, in part, by the Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS); and, in part, with Federal funds from NICHD/NIH/DHHS under Contract No. HHSN275201300006C. RR has contributed to this work as part of his official duties as an employee of the United States Federal Government. Hadassah Hebrew University has a Federal Wide Assurance with the Office for Human Research Protections (OHRP) of the Department of Health and Human Services (DHHS) of the United States. The funder had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication. Funding Information: This research was supported, in part, by the Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS); and, in part, with Federal funds from NICHD/NIH/DHHS under Contract No. HHSN275201300006C. RR has contributed to this work as part of his official duties as an employee of the United States Federal Government. Hadassah Hebrew University has a Federal Wide Assurance with the Office for Human Research Protections (OHRP) of the Department of Health and Human Services (DHHS) of the United States. The funder had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication. Publisher Copyright: Copyright {\textcopyright} 2023 Luxenbourg, Porat, Romero, Raif Nesher, Haj Yahya, Sompolinsky, Hochler, Ezra and Kabiri.",

year = "2023",

doi = "10.3389/fmed.2023.1130942",

language = "American English",

volume = "10",

journal = "Frontiers in Medicine",

issn = "2296-858X",

publisher = "Frontiers Media S.A.",

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Luxenbourg, D, Porat, S, Romero, R, Raif Nesher, D, Haj Yahya, R, Sompolinsky, Y, Hochler, H, Ezra, Y & Kabiri, D 2023, 'The effectiveness of vaginal progesterone in reducing preterm birth in high-risk patients diagnosed with short cervical length after 24 weeks: A retrospective cohort study', Frontiers in Medicine, vol. 10, 1130942. https://doi.org/10.3389/fmed.2023.1130942

TY - JOUR

T1 - The effectiveness of vaginal progesterone in reducing preterm birth in high-risk patients diagnosed with short cervical length after 24 weeks

T2 - A retrospective cohort study

AU - Luxenbourg, Danielle

AU - Porat, Shay

AU - Romero, Roberto

AU - Raif Nesher, Dror

AU - Haj Yahya, Rani

AU - Sompolinsky, Yishai

AU - Hochler, Hila

AU - Ezra, Yossef

AU - Kabiri, Doron

N1 - Funding Information: This research was supported, in part, by the Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS); and, in part, with Federal funds from NICHD/NIH/DHHS under Contract No. HHSN275201300006C. RR has contributed to this work as part of his official duties as an employee of the United States Federal Government. Hadassah Hebrew University has a Federal Wide Assurance with the Office for Human Research Protections (OHRP) of the Department of Health and Human Services (DHHS) of the United States. The funder had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication. Funding Information: This research was supported, in part, by the Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services (NICHD/NIH/DHHS); and, in part, with Federal funds from NICHD/NIH/DHHS under Contract No. HHSN275201300006C. RR has contributed to this work as part of his official duties as an employee of the United States Federal Government. Hadassah Hebrew University has a Federal Wide Assurance with the Office for Human Research Protections (OHRP) of the Department of Health and Human Services (DHHS) of the United States. The funder had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication. Publisher Copyright: Copyright © 2023 Luxenbourg, Porat, Romero, Raif Nesher, Haj Yahya, Sompolinsky, Hochler, Ezra and Kabiri.

PY - 2023

Y1 - 2023

N2 - Objective: To assess the impact of progesterone treatment on maternal and neonatal outcomes in women with a history of preterm birth and short cervical length diagnosed after 24 weeks of gestation. Methods: A retrospective cohort study included women with a history of preterm birth and a transvaginal sonographic cervical length measurement of ≤ 25 mm, diagnosed between 24+0 and 33+6 weeks of gestation. Exclusion criteria included prior progesterone treatment, cervical cerclage, or pessary. The study population was divided into the progesterone treatment group and the non-treatment group. Results: The study included 104 women, with 46.2% (48/104) receiving progesterone treatment and 53.8% (56/104) not receiving treatment. The rate of spontaneous preterm birth before 37 weeks of gestation was 43% (24/56) in the non-treatment group and 31% (15/48) in the progesterone treatment group (P = 0.14); the rate of spontaneous preterm birth before 34 weeks was 7% (4/56) in the non-treatment group and 0% (0/48) in the progesterone treatment group (P = 0.05). Progesterone treatment was associated with a significant decrease in neonatal intensive care unit admissions (OR 0.20, 95% CI 0.05–0.74) and in the neonatal hospitalization period (mean difference in days 2.43, 95% CI 0.44–4.42). The risk of recurrent spontaneous preterm birth was highest (71%) among women with two or more previous preterm deliveries who did not receive progesterone treatment, and lowest (24%) among women with one previous preterm delivery who received progesterone treatment. Conclusion: Progesterone treatment was associated with a reduction in rates of spontaneous preterm birth before 34 weeks of gestation, neonatal intensive care unit admission, and neonatal length of stay in high-risk patients, even when initiated after 24 weeks of gestation.

AB - Objective: To assess the impact of progesterone treatment on maternal and neonatal outcomes in women with a history of preterm birth and short cervical length diagnosed after 24 weeks of gestation. Methods: A retrospective cohort study included women with a history of preterm birth and a transvaginal sonographic cervical length measurement of ≤ 25 mm, diagnosed between 24+0 and 33+6 weeks of gestation. Exclusion criteria included prior progesterone treatment, cervical cerclage, or pessary. The study population was divided into the progesterone treatment group and the non-treatment group. Results: The study included 104 women, with 46.2% (48/104) receiving progesterone treatment and 53.8% (56/104) not receiving treatment. The rate of spontaneous preterm birth before 37 weeks of gestation was 43% (24/56) in the non-treatment group and 31% (15/48) in the progesterone treatment group (P = 0.14); the rate of spontaneous preterm birth before 34 weeks was 7% (4/56) in the non-treatment group and 0% (0/48) in the progesterone treatment group (P = 0.05). Progesterone treatment was associated with a significant decrease in neonatal intensive care unit admissions (OR 0.20, 95% CI 0.05–0.74) and in the neonatal hospitalization period (mean difference in days 2.43, 95% CI 0.44–4.42). The risk of recurrent spontaneous preterm birth was highest (71%) among women with two or more previous preterm deliveries who did not receive progesterone treatment, and lowest (24%) among women with one previous preterm delivery who received progesterone treatment. Conclusion: Progesterone treatment was associated with a reduction in rates of spontaneous preterm birth before 34 weeks of gestation, neonatal intensive care unit admission, and neonatal length of stay in high-risk patients, even when initiated after 24 weeks of gestation.

KW - admission to neonatal intensive care unit

KW - prematurity

KW - preterm delivery

KW - preterm labor

KW - progesterone

KW - progestogen

KW - short cervix

UR - http://www.scopus.com/inward/record.url?scp=85150344438&partnerID=8YFLogxK

U2 - 10.3389/fmed.2023.1130942

DO - 10.3389/fmed.2023.1130942

M3 - Article

C2 - 36936220

AN - SCOPUS:85150344438

SN - 2296-858X

VL - 10

JO - Frontiers in Medicine

JF - Frontiers in Medicine

M1 - 1130942

ER -

The effectiveness of vaginal progesterone in reducing preterm birth in high-risk patients diagnosed with short cervical length after 24 weeks: A retrospective cohort study

Abstract

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Keywords

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