Progesteron for Preterm
Labour Prevention
Prof.Dr.S.Cansun DEMİR
President of FGOM
16.May.2013-Antalya
Preterm labour

Delivery before 37 weeks of
gestation
 75 - 85 % Perinatal Mortality
 50 %
Long term morbidity
Progesteron in preterm labour
ACOG, suggests progesteron for the
prevention of preterm labour.
 Its mechanism is not well known
 What are the indications for
progesteron ?
 What must be the type of progesteron
and, route of usage and dosage ?

Progesteron, blocks the Prostaglandin
F2α and α-adrenergic receptors which
is necessary for uterus contractility
and leads to uterine relaxation.
 Decreases the oxytocin receptors in
uterus ,
 Up regulation of nitric okside and
blockage of intracellular gap junctions
lead to myometrial relaxation.

Erny et al.had showed the tocolytic
effect of oral micronized progesterone
in 1985.
 400 mg oral micronized progesteron
usage decreasespreterm labour by
88 %. Placebo is found to be effective in
42 %.

Combination of micronized
progesteron with, β-adrenergic
agonists, leads to decrease of the
dosage of β- agonist.
 Its tocolytic effect is similar .
 Cost and risk decreases.
 It may lead to increase in hepatic
enzymes.

Natural Progesteron
Natural progesteron begins from,18-25th.
weeks,given 90-400 mg/daily and generally
used vaginally.
 Oral micronized progesteron is an alternative.
 There is no hepatic first pass effect by
vaginal route and biotolerability is better.
 Endometrial effect is higher by vaginal route
comparing to parenteral usage. There is
uterin first-pass effect.

Synthetic Progesteron
(17-α-hidroksiprogesteron)
Synthetic progesteron is used by İ.M.
Route.
 Dosage changes from 25-1000 mg 1-3
times a week.
 There is side effects in 50 % of the
cases .
 In the 4 year follow-up of the babies
no long term effects, genital anomaly
or sexuality role changes was noticed.

Indications of Progesteron for
preterm labour
History of preterm labour
 Short cervix
 Multipl pregnancy
 Threatened preterm labour

History of preterm birth
PTL decreases 30-50 % in patients
with a history of previous PTB.
 There is a decrease in newborns
< 2500 gr 3-40 %.
 Mean birth weight was 475 grs more
in progesterone group.

“
Dodd JM.Progesterone for the Prevention of Preterm Birth Obstetrics
&Gynecology,2008,112,129-134
Patients with PTH history
Dr.Elçin Erçetingöz Yüksek Riskli gebelerde Preterm Eylem ve
Doğumun Önlenmesinde Mikronize Progesteronun İntravajinal
Kullanımı Uzmanlık Tezi Zeynep Kamil Hastanesi, 2007
Short Cervix

Cases with ≤ 15 mm cervical length,
administration of 200 mg vaginal
progesteron decreases preterm birth <
34 weeks by 45-50 %.
Dodd JM.Progesterone for the Prevention of Preterm Birth Obstetrics
&Gynecology,2008,112,129-134
Fonseca E.B. et al. Progesterone and the risk of Preterm Birth among
Women with a Short cervix NEJM, 2007,357;5, 464-469
Fonseca E.B. et al. Progesterone and the risk of Preterm Birth among
Women with a Short cervix NEJM, 2007,357;5, 464-469
Multipl Pregnancy
In unselected twin pregnancies usage
of İ.M. 17P does not influence deliveries
<35 weeks.
 200 mg vaginal progesteron does not
effect multipl pregnancies with
shortened cervix.

Dodd JM.Progesterone for the Prevention of Preterm Birth Obstetrics
&Gynecology,2008,112,129-134
Birth in Twin pregnancies before
37 weeks
Dr.Elçin Erçetingöz Yüksek Riskli gebelerde Preterm Eylem ve
Doğumun Önlenmesinde Mikronize Progesteronun İntravajinal
Kullanımı Uzmanlık Tezi Zeynep Kamil Hastanesi, 2007
Arrested Preterm Labour
Vaginal progesteron with a dosage of
400 mg/day was given to 70 patients
with arrested (threatened) labour.
 Birth was prolonged for 12 days.
 Low birth weight RR 0.52,
 RDS risk 0.30.
 NICU admission decreases from 39 %
to ’ 24%.
 Neonatal sepsis decreases from 18% to
5 %.

Combined results without risk
factors
Preterm labours are prevented and
low birth weight decreases by 40-50%.
 IVH decreases 75% and NEC
decreases.
 Progesteron dosage was not found to
be significant .

PTB in Progesteron
Dr.Elçin Erçetingöz Yüksek Riskli gebelerde Preterm Eylem ve
Doğumun Önlenmesinde Mikronize Progesteronun İntravajinal
Kullanımı Uzmanlık Tezi Zeynep Kamil Hastanesi, 2007
NICU admission
Dr.Elçin Erçetingöz Yüksek Riskli gebelerde Preterm Eylem ve
Doğumun Önlenmesinde Mikronize Progesteronun İntravajinal
Kullanımı Uzmanlık Tezi Zeynep Kamil Hastanesi, 2007
Take Home Message
1. Patients with PTB , usage of vaginal
progesteron > 100 mg/daily dose after
24 weeks is found to be effective in
prevention of PTL.
 2.In patients with short cervix
(≤ 15 mm) usage of 200 mg vaginal
progesteron was found to be effective.

3.In twin pregnancies routine usage of
progesteron is not indicated but for
selected cases with PTB history or short
cx may be used.
 4.In arrested PTL cases daily 400 mg
vaginal progesteron may be used.

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