Prevention of spontaneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment

  title={Prevention of spontaneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment},
  author={Roberto J. Romero},
  journal={Ultrasound in Obstetrics and Gynecology},
  • R. Romero
  • Published 1 October 2007
  • Biology, Medicine
  • Ultrasound in Obstetrics and Gynecology
The importance of progesterone in the maintenance of mammalian pregnancy is well established1–18. Similarly, a decline in progesterone action is believed to be central to the initiation of parturition in most mammalian species, including primates5,7,8,12–14,19,20, although the precise mechanism for this in humans has not been elucidated5,7,9,13,14,21–25. Progestogen (a term that, like progestin, includes both ‘natural’ progesterone and synthetic compounds with progesterone action)26… 
Progesterone to prevent preterm birth in twin gestations: what is the next step forward?
  • R. Romero
  • Biology, Medicine
    BJOG : an international journal of obstetrics and gynaecology
  • 2013
Progesterone is a key hormone for pregnancy maintenance, and a decline in progesterone action is considered to be central to the initiation of parturition in most mammalian species, including primates, so it is not surprising that many investigators have explored the use of progestersone for the prevention of preterm birth.
The effect of prenatal vaginal progesterone on cervical length in nonselected twin pregnancies
Cervical shortening in asymptomatic nonselected twin pregnancies occurred at a similar rate, regardless of vaginal progesterone treatment, according to gestational age at birth.
Vaginal Progesterone to Reduce the Rate of Preterm Birth and Neonatal Morbidity: A Solution at Last
ISSN 1745-5057 Women's Health (2011) 7(5), 501–504 10.2217/WHE.11.60 shortand long-term complications. However, age alone does not tell us why the preterm birth occurred, and this has profound
A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix
Routine assessment of the risk of preterm birth with cervical ultrasound coupled with vaginal progesterone for women with a short cervix is cost-effective, and the implementation of such a policy is urgently needed.
Management strategies for the prevention of preterm birth: part II – update on cervical cerclage
Understanding that high-risk populations are not homogeneous and no single-approach modality is likely to be generally applicable, this work has combined the available evidence on both progesterone and cerclage to provide guidance on how to identify subgroups of women at significantly increased risk for PTB and how to preferentially consider progester one versus cerClage.
Vaginal progesterone after tocolytic therapy in threatened preterm labor
The administration of vaginal progesterone after tocolysis in threatened preterm labor is associated with prolongation of pregnancy, and the reduction of deliveries before 34 weeks was observed in patients presenting with contractions after 27 weeks gestation.


Mechanisms of progesterone action in inhibiting prematurity
  • A. Sfakianaki, E. Norwitz
  • Biology, Medicine
    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
  • 2006
Six putative mechanisms by which progesterone is able to maintain uterine quiescence and prevent preterm birth in some high-risk women are explored in this review.
Regulation of the Uterus and Cervix during Pregnancy and Labor Role of Progesterone and Nitric Oxide
The role of progesterone and NO in controlling pregnancy is focused on, with a focus on the lack of clear biophysical and biochemical indicators of the conversion from unproductive uterine contractions to those capable of inducing progressive cervical dilatation.
Efficacy of progesterone support for pregnancy in women with recurrent miscarriage. A meta‐analysis of controlled trials
  • S. Daya
  • Medicine, Biology
    British journal of obstetrics and gynaecology
  • 1989
There is evidence to support the suggestion that progesterone given in early pregnancy is useful in women with recurrent miscarriage, according to the resulting odds ratio for pregnancies reaching at least 20 weeks gestation.
Progestogen for preventing miscarriage.
There is no evidence to support the routine use of progestogen to prevent miscarriage in early to mid pregnancy, and further trials in women with a history of recurrent miscarriage may be warranted.
Progesterone and the risk of preterm birth among women with a short cervix.
In women with a short cervix, treatment with progesterone reduces the rate of spontaneous early preterm delivery and is associated with a nonsignificant reduction in neonatal morbidity.
Hormone trajectories leading to human birth
Prenatal administration of progesterone for preventing preterm birth.
Intramuscular progesterone is associated with a reduction in the risk of preterm birth less than 37 weeks' gestation, and infant birthweight less than 2500 grams.
Transvaginal Ultrasonography of the Cervix to Predict Preterm Birth in Women With Uterine Anomalies
A short cervical length on transvaginal ultrasonography in women with uterine anomalies has a 13-fold risk for preterm birth.