Role of vaginal progesterone in reducing the rate of preterm labour in women with a sonographic short cervix


  • Kirtirekha Mohapatra Department of Obstetrics & Gynaecology, SCB Medical College, Cuttack, Odisha, India
  • Subhra Ghosh Department of Obstetrics & Gynaecology, SCB Medical College, Cuttack, Odisha, India
  • Rabinarayan Dash Department of Obstetrics & Gynaecology, SCB Medical College, Cuttack, Odisha, India
  • Balaram Sahoo Department of Obstetrics & Gynaecology, SCB Medical College, Cuttack, Odisha, India



Preterm labour, Progesterone, Short cervix


Background: Preterm labour is responsible for not only neonatal morbidity and mortality but also has long term consequences .Till now there is no effective method of prevention. Progesterone has shown promising result. But ideal candidate, ideal route and when to start the treatment are still in dilemma. The present study was undertaken to know the role of progesterone on pregnant women with sonographically short cervix.

Methods: This prospective case control study was started on 100 pregnant women with sonographic short cervix (≤2.5 cm) and between 19 – 29 weeks of gestation. 60 women, some with history of midtrimester abortion or preterm labour and some without this history were treated as cases and were given vaginal progesterone pessary 200 mg once daily till rupture of membrane or onset of labour or up to 36 weeks of gestation whichever is earlier. 40 women without any history of midtrimester abortion or preterm labour were treated as control and followed up.

Results: Among the cases 18.3%, delivered preterm and 81.7% were term deliveries. Respective proportions among control were 40% and 60% respectively. 26 among the cases and all women of control group did not have history of preterm labour and mid trimester abortion. In the case group 26.9% and in the control group 40% had preterm deliveries. Though the proportion of labour was lower among the cases it is not statistically significant (p = 0.276). There is mean prolongation of gestational age by 8.4± 1.29 weeks in case group in present pregnancy compared the previous one in cases with history of preterm labour and midtrimester abortion which was statistically significant .When neonatal complication are compared there is no significant difference between the two groups.

Conclusions: Vaginal progesterone started from midtrimester in pregnant ladies with short cervix with previous history of midtrimester abortion or preterm labour is effective in reducing the rate of preterm birth.


Huddy CL, Johnson A, Hope PL. Educational and behavioral problems in babies of 32–35 weeks gestation. Arch Dis Child Fetal Neonatal Ed. 2001;85:23F-8.

Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatrics. 2004;114:372-6.

Lawn JE, Wilczynska-Ketende K, Cousens SN. Estimating the causes of 4 million neonatal deaths in the year 2000. Int J Epidemiol. 2006;35:706-18.

Petrou S. The economic consequences of preterm birth during the first 10 years of life. BJOG. 2005;112:10-5.

Petrou S, Mehta Z, Hockley C, Cook-Mozaffari P, Henderson J, Goldacre M. The impact of preterm birth on hospital inpatient admissions and costs during the first 5 years of life. Pediatrics. 2003;112:1290-7.

WHO bulletin2010:85-31-38

Norwitz ER, Robinson JN, Challis JRG. The control of labor. N Engl J Med. 1999;341:660-6.

Challis JRG, Matthews SG, Gibb W, Lye SJ. Endocrine and paracrine regulation of birth at term and preterm. Endocr Rev. 2000;21:514-50.

Norwitz ER, Lye SJ. Biology of parturition. In: Creasy RK, Resnick R, Iams JD, editors. Creasy & Resnick’s Maternal-Fetal Medicine. 6th ed. Philadelphia: Elsevier. 2009:69-85.

Society for Maternal Fetal Medicine Publications Committee, authors. ACOG Committee Opinion number 419 October 2008 (replaces no. 291, November 2003). Use of progesterone to reduce preterm birth. Obstet Gynecol. 2008;112:963-5.

Romero R. Vaginal progesterone to reduce the rate of preterm birth and neonatal morbidity: a solution at last.Women's Health. 2011;7:501-4.

Chwalisz K, Shi Shao O, Neff G, Elger J. The effect of antigestagen ZK 98, 199 on the uterine cervix. Acta Endocrinol. 1987;283:113.

Norman J. Antiprogesterones. Br J Hosp Med. 1991;45:372-5.

Elliott CL, Brennand JE, Calder AA. The effects of mifepristone on cervical ripening and labor induction in primigravidae. Obstet Gynecol. 1998;92:804-9.

Gamze, Cidgem S, Senol K. Evaluation of cervix by TAS TVS in 2nd trimester. J Obstet Gynecol India. 2005;55(4).

Romero R, Nicolaides K, Conde-Agudelo A, Tabor A, O'Brien JM, Cetingoz E. Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data. Am J Obstet Gynecol. 2012;206(124.e1–19).

Creasy GW, Romero R, Hassan S. The Effect of Vaginal Progesterone Administration in the Prevention of Preterm Birth in Women With a Short Cervix, 2012. [Vaginal Progesterone Bioadhesive Gel (Prochieve)® Extending Gestation A New Therapy for Short Cervix - Trial (PREGNANT Short Cervix - Trial)].

Timor- Tritsch I, Boozarjomehri E, Maskowski Y, Monteagudo A, Chao CR. Can a snap shot saggital view of the cervix by transvaginal usg predict active preterm labour? Am J Obstet Gynecol. 1996;174:990-5.

Da Fonseca EB, Bittar RE, Carvalho MH, Zugaib M. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study. Am J Obstet Gynecol. 2003;188:419-24.






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