Erken Doğumda
Progesteron Kullanımı
Dr. Erkan Çağlıyan
Dokuz Eylül Üniversitesi Tıp Fakültesi
Kadın Hastalıkları ve Doğum Anabilim Dalı
Preterm Doğum Hızı
% 11.8
Preterm Doğum
Erken Doğum
Sınıflama
Akut Preterm Eylemde
Tokolitik Tedavi
Tocolytic therapy for preterm delivery: systematic review and network meta-analysis
.BMJ 2012
Erken Doğum –Öngörüsü
‘Prediction is the basis of Prevention’
Goldenberg et al. American Journal of Public Health,1998
Erken Doğum -Öngörüsü
Goldenberg et al. American Journal of Public Health,1998
Comparison 11. Comparison 01 FFN knowledge versusno knowledge, Outcome 11 Time to evaluate (hours)
Outcome or subgroup title
Erken Doğum -Öngörüsü
Fetal Fibronectin
No. of
No. of
studies participants
1 Outcome 11 Time to evaluate
3
234
Statistical method
Mean Difference (IV, Fixed, 95% CI)
Effect size
0.04 [-0.39, 0.47]
Analysis 1.1. Comparison 1 Comparison 01 FFN knowledge versus no knowledge, O utcome 01 Preterm
birth < 37 week, O utcome 1 O utcome 01 Preterm birth < 37 weeks.
Review: Fetal fibronectin testing for reducing the risk of preterm birth
Comparison: 1 Comparison 01 FFN knowledge versus no knowledge, Outcome 01 Preterm birth < 37 week
Outcome: 1 Outcome 01 Preterm birth < 37 weeks
Study or subgroup
Treatment
Control
n/N
n/N
10/50
13/50
33.1 %
0.77 [ 0.37, 1.59 ]
Ness 2007
6/42
15/43
37.7 %
0.41 [ 0.18, 0.95 ]
Plaut 2003
5/43
12/47
29.2 %
0.46 [ 0.17, 1.19 ]
135
140
100.0 %
0.54 [ 0.34, 0.87 ]
Grobman 2004
Total (95% CI)
Risk Ratio
Weight
M-H,Fixed,95%CI
Risk Ratio
M-H,Fixed,95% CI
Total events: 21 (Treatment), 40 (Control)
Heterogeneity: Chi2 = 1.44, df = 2 (P = 0.49); I2 =0.0%
Test for overall effect: Z = 2.53 (P = 0.011)
Test for subgroup differences: Not applicable
0.05
0.2
Favours treatment
1
5
20
Favours control
Fetal fibronectin testing for reducing the risk of preterm birth (Review)
Copyright © 2008 T he Cochrane Collaboration. Published by John W iley & Sons, Ltd.
Berghella V. et al, Cochrane Review,2008
15
Erken Doğum Öngörüsü
Fetal Fibronectin
Analysis 2.1. Comparison 2 Comparison 01 FFN knowledge versus no knowledge, O utcome 02 Preterm
birth < 34 week, O utcome 1 O utcome 02 Preterm birth < 34 week.
Review: Fetal fibronectin testing for reducing the risk of preterm birth
Comparison: 2 Comparison 01 FFN knowledge versus no knowledge, Outcome 02 Preterm birth < 34 week
Outcome: 1 Outcome 02 Preterm birth < 34 week
Study or subgroup
Treatment
Control
n/N
n/N
Grobman 2004
5/50
3/50
33.5 %
1.67 [ 0.42, 6.60 ]
Ness 2007
2/46
4/45
45.2 %
0.49 [ 0.09, 2.54 ]
Plaut 2003
2/43
2/47
21.3 %
1.09 [ 0.16, 7.42 ]
139
142
100.0 %
1.01 [ 0.41, 2.47 ]
Total (95% CI)
Risk Ratio
Weight
M-H,Fixed,95%CI
Risk Ratio
M-H,Fixed,95%CI
Total events: 9 (Treatment), 9 (Control)
Heterogeneity: Chi2 = 1.26, df = 2 (P = 0.53); I2 =0.0%
Test for overall effect: Z = 0.03 (P = 0.98)
Test for subgroup differences: Not applicable
0.01
0.1
Favours treatment
1
10
100
Favours control
Berghella V. et al, Cochrane Review,2008
Erken Doğum Öngörüsü
Fetal Fibronectin
Analysis 3.1. Comparison 3 Comparison 01 FFN knowledge versus no knowledge, O utcome 03 Preterm
birth < 32 week, O utcome 1 O utcome 03 Preterm birth < 32 week.
Review: Fetal fibronectin testing for reducing the risk of preterm birth
Comparison: 3 Comparison 01 FFN knowledge versus no knowledge, Outcome 03 Preterm birth < 32 week
Outcome: 1 Outcome 03 Preterm birth < 32 week
Study or subgroup
Treatment
Control
n/N
n/N
Grobman 2004
3/50
2/50
30.6 %
1.50 [ 0.26, 8.60 ]
Ness 2007
0/47
3/45
54.7 %
0.14 [ 0.01, 2.58 ]
Plaut 2003
2/43
1/47
14.6 %
2.19 [ 0.21, 23.26 ]
140
142
100.0 %
0.85 [ 0.28, 2.58 ]
Total (95% CI )
Risk Ratio
Weight
M-H,Fixed,95%CI
Risk Ratio
M-H,Fixed,95%CI
Total events: 5 (Treatment), 6 (Control)
Heterogeneity: Chi2 = 2.50, df = 2 (P = 0.29); I2 =20%
Test for overall effect: Z = 0.28 (P = 0.78)
Test for subgroup differences: Not applicable
0.01
0.1
1
Favours treatment
10
100
Favours control
Berghella V. et al, Cochrane Review,2008
Erken Doğum Öngörüsü
Fetal Fibronectin
• Asemptomatik hastalarda erken doğum için tarama testi olarak
duyarlılığı düşük
• Etkin tedavi seçenekleri sınırlı
• Asemptomatik hastalarda test (+) olması halinde bile < 1 hft
doğum ihtimali az
• Erken Doğum Taraması amacıyla kullanılması önerilmemekte
• Semptomatik hastalada triaj için yararlı
ACOG Practice Bulletin, Number 130, 2012
Erken Doğum -Öngörüsü
Transvaginal Servikal Uzunluk
Prediction of Preterm Birth: Cervical Sonography
Maria Teresa Mella, MD, and Vincenzo Berghella, MD
The cervix has to open to allow vaginal birth. Ultrasound has now shown that this lower part
of the uterus begins to show changes weeks before eventual birth. Only transvaginal
ultrasound should be used to evaluate the cervix for prediction of preterm birth (PTB). The
shortest best cervical length (CL) is the most effective measurement for clinical use. Proper
technique is paramount for accurate results. The risk of PTB increases with ever shorter CL
(< 25 mm). Other factors that must be carefully considered when using CL for prediction of
PTB are number of fetuses, risk factors for PTB, and gestational age at screening.
Semin Perinatol 33:317-324 © 2009 Elsevier Inc. All rights reserved.
KEYWORDScervical length, prediction, preterm birth
Erken Doğum -Öngörüsü
Transvaginal Servikal Uzunluk
Prediction of Preterm Birth: Cervical Sonography
Maria Teresa Mella, MD, and Vincenzo Berghella, MD
The cervix has to open to allow vaginal birth. Ultrasound has now shown that this lower part
of the uterus begins to show changes weeks before eventual birth. Only transvaginal
ultrasound should be used to evaluate the cervix for prediction of preterm birth (PTB). The
shortest best cervical length (CL) is the most effective measurement for clinical use. Proper
technique is paramount for accurate results. The risk of PTB increases with ever shorter CL
(< 25 mm). Other factors that must be carefully considered when using CL for prediction of
PTB are number of fetuses, risk factors for PTB, and gestational age at screening.
Semin Perinatol 33:317-324 © 2009 Elsevier Inc. All rights reserved.
KEYWORDS cervical length, prediction, preterm birth
Prediction Is the
Basis of P r evention
support the efficacy of cervical sonography in the prevention
of PTB.
The aim of any healthcare worker assisting a patient is to
prevent disease. Often, the first step in preventing disease is
early prediction. In thecaseof preterm birth (PTB), oneof the
best, if not the best, predictive test has been shown to be
cervical sonography. The cervix has to open to allow vaginal
birth. As we have known for decades, the process of parturition takes months of preparation, and early changes can be
detected in human beings.
With regard to the cervix, ultrasound has now shown that
this lower part of the uterus begins to show changes weeks
before eventual birth. Even for PTB, which often we had
characterized in the past as something happening suddenly
and unexpectantly, the changes are gradual and usually very
slow. In fact, in many high-risk women delivering preterm,
thecervix starts to shorten afew monthsbeforepreterm labor
Evaluation of C ervical
Length–Technical A spects
Evaluation of cervical length (CL) may be done either sonographically or through direct physical examination of the
cervix. Sonographic detection of CL may be approached
through transabdominal, translabial, or transvaginal routes,
with each method having its own benefits and limitations.
Physical Examination
In the past, serial digital and speculum examinations have
been used to follow-up women with suspected cervical insufficiency. The physical changes notable on examination, revealing the likelihood of cervical insufficiency, include bulg-
 Servikal uzunluk cut-off 25 mm
< 34 hft doğum için sensivite %36
spesifite %94
Transvaginal Ultrason Servikal Uzunluk
Ölçüm Tekniği
 Cervical Length Education and Review
CLEAR
https://clear.perinatalquality.org
Erken Doğum -Öngörüsü
TV Cl –Ne Zaman ?
Çoğul Gebelikler
Tarama önerilmemekte
Tekil Gebelikler
Obstetrik Öykü
TVU CL Ölçümü
CL Ölçüm Sıklığı
Erken Doğum Öyküsü Yok
18-24 hft (?)
14-27 hft erken doğum
14 -24 hft
2 hft aralarla
25-30 mm haftada
28-36 hft erken doğum
16-24 hft
2 hft aralarla
25-30 mm haftada
Erken Doğum –Önlenmesi
Progesteron
Progesteron: CAP gen ekspresyonunda
azalma (iyon kanalları,oksitosin ve prostaglandin res., gap junction)
Hangi hastalar?
Progesteron tipi ,dozu,uygulama yolu?
Hasta Seçimi
Prenatal administration of progesterone for preventing
preterm birth in women considered to be at risk of preterm
birth (Review)
Dodd JM, JonesL, Flenady V, Cincotta R, Crowther CA
 Spontan preterm doğum öyküsü olan hastalar?
 TVU CL kısa saptanan hastalar?
 Çoğul Gebelikler ?
Thisisareprint of aCochranereview, prepared and maintained by TheCochraneCollaboration and published in TheCochraneLibrary
2013, Issue 7
http://www.thecochranelibrary.com
3.1 Supplementation
commenced prior to 20 weeks’
gestation
3.2 Supplementation
commenced after 20 weeks’
gestation
1
168
Risk Ratio (M -H , Random, 95% CI )
0.83 [0.30, 2.27]
1
99
Risk Ratio (M -H , Random, 95% CI )
0.25 [0.05, 1.10]
Spontan preterm doğum öyküsü
Perinatal Mortalite?
A nalysis 1.1.
Review:
C om par ison 1 Pr ogest erone ver sus placebo/no t reat m ent : previous hist or y spont aneous
pret er m bir t h ( singlet ons) , O ut com e 1 Per inat al m or t alit y.
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at risk Thisisare
of preterm
bir th
print of aCochra
nereview, prepared and maintained by TheCochraneCollaboration and pu
2013, Issue 7
Comparison:
Outcome:
http://www.thecochranelibrary.com
1 Progesterone versus placebo/no treatment: previous histor y spontaneous preterm bir th (singletons)
1 Perinatal mor tality
Study or subgroup
Progesterone
Placebo
n/N
n/N
Risk Ratio
Weight
Risk Ratio
Ibrahim 2010
4/25
13/25
21.0 %
0.31 [ 0.12, 0.81 ]
J
ohnson 1975
0/18
7/26
10.0 %
0.09 [ 0.01, 1.56 ]
14/306
11/153
23.7 %
349
204
M-H,Fixed,95% CI
M-H,Fixed,95% CI
1 Intramuscular
Meis 2003
Subtotal (95% CI )
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk of p
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
54.8 %
0.64 [ 0.30, 1.37 ]
0.41 [ 0.23, 0.73 ]
Total events: 18 (Progesterone), 31 (Placebo)
Heterogeneit y: Chi2 = 2.65, df = 2 (P = 0.27); I2 = 24%
Test for overall effect: Z = 3.01 (P = 0.0026)
2 Vaginal
Akbari 2009
O’Brien 2007
3/69
10/72
15.8 %
11/309
11/302
18.0 %
378
374
Subtotal (95% CI )
33.9 %
0.31 [ 0.09, 1.09 ]
0.98 [ 0.43, 2.22 ]
0.67 [ 0.34, 1.29 ]
Total events: 14 (Progesterone), 21 (Placebo)
Heterogeneit y: Chi2 = 2.25, df = 1 (P = 0.13); I2 = 55%
Test for overall effect: Z = 1.20 (P = 0.23)
3 O ral
Rai 2009
3/74
7/74
74
74
11.3 %
0.43 [ 0.12, 1.59 ]
801
652
100.0 %
0.50 [ 0.33, 0.75 ]
Subtotal (95% CI )
11.3 %
0.43 [ 0.12, 1.59 ]
Total events: 3 (Progesterone), 7 (Placebo)
Heterogeneit y: not applicable
Test for overall effect: Z = 1.26 (P = 0.21)
Total (95% CI )
Total events: 35 (Progesterone), 59 (Placebo)
Heterogeneit y: Chi2 = 5.85, df = 5 (P = 0.32); I2 = 15%
Test for overall effect: Z = 3.31 (P = 0.00094)
Test for subgroup differences: Chi2 = 1.21, df = 2 (P = 0.55), I2 = 0.0%
0.1
0.2
0.5
Favours progesterone
1
2
5
10
Favours placebo
IM progesteron kullanımı perinatal mortalitede azalma
RR : 0.41 (0.23-0.73)
Prenat al adm inist r at ion of progest erone for prevent ing pret er m bir t h in wom en considered t o be at r isk of pret er m bir t h (Review)
Copyr ight © 2013 T he Cochr ane Collabor at ion. Published by John W iley & Sons, Lt d.
105
Spontan preterm doğum öyküsü
37 hft önce doğum ?
A nalysis 1.3.
Review:
C om par ison 1 Pr ogest er one ver sus placebo/no t r eat m ent : previous hist or y spont aneous
pr et er m bir t h ( singlet ons) , O ut com e 3 Pr et er m bir t h less t han 37 weeks.
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at risk of preterm bir th
Comparison:
Outcome:
1 Progesterone versus placebo/no treatment: previous histor y spontaneous preterm bir th (singletons
)
Thisisare
print of aCochranereview, prepared and maintained by TheCochraneCollaboration and pu
2013, Issue 7
http://www.thecochranelibrary.com
3 Preterm bir th less than 37 weeks
Study or subgroup
Progesterone
Placebo
Risk Ratio
MH,Random,95%
CI
Weight
Risk Ratio
MH,Random,95%
CI
n/N
n/N
Ibrahim 2010
8/25
13/25
9.0 %
0.62 [ 0.31, 1.22 ]
J
ohnson 1975
2/18
12/25
3.5 %
0.23 [ 0.06, 0.91 ]
111/306
84/153
16/50
30/50
399
253
1 Intramuscular
Meis 2003
Saghafi 2011a
Subtotal (95% CI )
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk of p
Copyright © 2013
T0
he %
Cochrane Collaborat ion. Published
by John
W54,
iley & 0.
Sons,
Lt]
d.
17.
0.66
[ 0.
81
12.5 %
42.1 %
0.53 [ 0.34, 0.85 ]
0.62 [ 0.52, 0.75 ]
Total events: 137 (Progesterone), 139 (Placebo)
Heterogeneit y: Tau2 = 0.0; Chi2 = 2.84, df = 3 (P = 0.42); I2 = 0.0%
Test for overall effect: Z = 5.11 (P < 0.00001)
2 Vaginal
Akbari 2009
8/69
23/72
8.4 %
0.36 [ 0.17, 0.76 ]
Cetingoz 2011
9/37
17/34
9.3 %
0.49 [ 0.25, 0.94 ]
10/72
20/70
9.0 %
0.49 [ 0.25, 0.96 ]
6/50
19/50
7.2 %
0.32 [ 0.14, 0.72 ]
129/309
123/302
17.3 %
537
528
da Fonseca 2003
Majhi 2009
O’Brien 2007
Subtotal (95% CI )
51.2 %
1.03 [ 0.85, 1.24 ]
0.52 [ 0.29, 0.92 ]
Total events: 162 (Progesterone), 202 (Placebo)
Heterogeneit y: Tau2 = 0.32; Chi2 = 20.39, df = 4 (P = 0.00042); I2 = 80%
Test for overall effect: Z = 2.25 (P = 0.024)
3 O ral
Glover 2011
Subtotal (95% CI )
5/19
8/14
19
14
6.7 %
6.7 %
0.46 [ 0.19, 1.11 ]
0.46 [ 0.19, 1.11 ]
Total events: 5 (Progesterone), 8 (Placebo)
Heterogeneit y: not applicable
Test for overall effect: Z = 1.73 (P = 0.084)
0.1
0.2
0.5
Favour s progesterone
1
2
5
10
Favours placebo
(Continued . . . )
Prenat al adm inist r at ion of progest erone for prevent ing pret er m bir t h in wom en considered t o be at r isk of pret er m bir t h (Review)
Copyr ight © 2013 T he Cochr ane Collabor at ion. Published by J
ohn W iley & Sons, Lt d.
IM-Vaginal progesteron kullanımı 37 hft önce doğum oranında azalma
RR 0.55 (0.42,0.74)
107
Spontan preterm doğum öyküsü
34 hft önce doğum ?
A nalysis 1.2.
Review:
C om par ison 1 Progest erone ver sus placebo/no t reat m ent : previous hist or y spont aneous
pret er m bir t h ( singlet ons) , O ut com e 2 Pret er m bir t h less t han 34 weeks.
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at risk of preterm bir th
Thisisareprint of aCochranereview, prepared and maintained by TheCochraneCollaboration and pu
Comparison:
2013,
1 Progesterone versus placebo/no treatment: previous histor y spontaneous preterm bir th (singletons
) Issue 7
http://www.thecochranelibrary.com
Outcome:
2 Preterm bir th less than 34 weeks
Study or subgroup
Progesterone
Placebo
n/N
n/N
0
0
Akbari 2009
2/69
Cetingoz 2011
2/37
da Fonseca 2003
Majhi 2009
Risk Ratio
MH,Random,95%
CI
Weight
Risk Ratio
MH,Random,95%
CI
1 Intramuscular
Subtotal (95% CI )
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk of p
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
0.0 %
0.0 [ 0.0, 0.0 ]
16/72
17.4 %
0.13 [ 0.03, 0.55 ]
9/34
17.0 %
0.20 [ 0.05, 0.88 ]
2/72
13/70
17.1 %
0.15 [ 0.04, 0.64 ]
2/50
3/50
13.8 %
0.67 [ 0.12, 3.82 ]
228
226
65.3 %
0.21 [ 0.10, 0.44 ]
Total events: 0 (Progesterone), 0 (Placebo)
Heterogeneit y: not applicable
Test for overall effect: not applicable
2 Vaginal
Subtotal (95% CI )
Total events: 8 (Progesterone), 41 (Placebo)
Heterogeneit y: Tau2 = 0.0; Chi2 = 2.35, df = 3 (P = 0.50); I2 = 0.0%
Test for overall effect: Z = 4.10 (P = 0.000042)
3 Oral
Rai 2009
22/74
37/74
34.7 %
0.59 [ 0.39, 0.90 ]
74
74
34.7 %
0.59 [ 0.39, 0.90 ]
302
300
100.0 %
0.31 [ 0.14, 0.69 ]
Subtotal (95% CI )
Total events: 22 (Progesterone), 37 (Placebo)
Heterogeneit y: not applicable
Test for overall effect: Z = 2.44 (P = 0.015)
Total (95% CI )
Total events: 30 (Progesterone), 78 (Placebo)
Heterogeneit y: Tau2 = 0.45; Chi2 = 9.15, df = 4 (P = 0.06); I2 = 56%
Test for overall effect: Z = 2.87 (P = 0.0041)
Test for subgroup differences: Chi2 = 5.77, df = 1 (P = 0.02), I2 = 83%
0.05
0.2
Favours progesterone
1
5
20
Favour s placebo
Prenat al adm inist r at ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at r isk of pret er m bir t h (Review)
Copyright © 2013 T he Cochr ane Collaborat ion. Published by John W iley & Sons, Lt d.
Vaginal/Oral progesteron kullanımı
34 hft önce doğum oranında azalma 0.31 (0.14,0.69)
106
Spontan preterm doğum öyküsü
<2500 gr. doğum ?
A nalysis 1.9.
Com par ison 1 Progest erone ver sus placebo/no treatm ent: previous histor y spontaneous
pret er m bir t h (singlet ons), O ut com e 9 Infant bir t hweight less t han 2500 g.
Thisisareprint of aCochranereview, prepared and maintained by TheCochraneCollaboration and publish
Review:
2013,
Is
7 preterm bir th
Prenatal administration of progesterone for preventing preterm bir th in women considered to be a
t ris
ksue
of
http://www.thecochranelibrary.com
Comparison:
Outcome:
1 Progesterone versus placebo/no treatment: previous histor y spontaneous preterm bir th (singletons)
9 Infant bir thweight less than 2500 g
Study or subgroup
Progesterone
Placebo
Risk Ratio
MH,Random,95%
CI
Weight
Risk Ratio
MH,Random,95%
CI
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk of pret er
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
n/N
n/N
Ibrahim 2010
5/25
10/25
10.7 %
0.50 [ 0.20, 1.25 ]
Johnson 1975
4/18
11/26
9.6 %
0.53 [ 0.20, 1.39 ]
82/306
62/151
73.2 %
0.65 [ 0.50, 0.85 ]
349
202
93.5 %
0.63 [ 0.49, 0.81 ]
1 Intramuscular
Meis 2003
Subtotal (95% CI )
Total events: 91 (Progesterone), 83 (Placebo)
Heterogeneity: Tau2 = 0.0; Chi2 = 0.45, df = 2 (P = 0.80); I2 =0.0%
Test for overall effect: Z = 3.65 (P = 0.00027)
2 Vaginal
Akbari 2009
3/69
14/72
6.5 %
0.22 [ 0.07, 0.74 ]
69
72
6.5 %
0.22 [ 0.07, 0.74 ]
418
274
100.0 %
0.58 [ 0.42, 0.79 ]
Subtotal (95% CI )
Total events: 3 (Progesterone), 14 (Placebo)
Heterogeneity: not applicable
Test for overall effect: Z = 2.44 (P = 0.015)
Total (95% CI )
Total events: 94 (Progesterone), 97 (Placebo)
Heterogeneity: Tau2 = 0.02; Chi2 = 3.32, df = 3 (P = 0.34); I2 =10%
Test for overall effect: Z = 3.43 (P = 0.00061)
Test for subgroup differences: Chi2 = 2.75, df = 1 (P = 0.10), I2 =64%
0.1
0.2
0.5
Favours progesterone
1
2
5
10
Favours placebo
IM/Oral progesteron kullanımı
<2500 gr.doğum oranında azalma 0.58 (0.42,0.79)
Spontan preterm doğum öyküsü
Neonatal ölüm ?
A nalysis 1.20.
Review:
C om par ison 1 Progest erone ver sus placebo/no t reat m ent : previous hist or y spont aneous
pret er m bir t h ( singlet ons) , O ut com e 20 N eonat al deat h.
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at risk
of preterm
bir th
Thisisare
print of aCochra
nereview, prepared and maintained by TheCochraneCollaboration and pu
2013, Issue 7
Comparison:
Outcome:
1 Progesterone versus placebo/no treatment: previous histor y spontaneous preterm bir th (singletons)
http://www.thecochranelibrary.com
20 N eonatal death
Study or subgroup
Progesterone
Placebo
n/N
n/N
Risk Ratio
Weight
Ibrahim 2010
1/25
4/25
J
ohnson 1975
0/18
2/26
4.9 %
8/306
9/153
28.6 %
349
204
M-H,Fixed,95% CI
Risk Ratio
M-H,Fixed,95% CI
1 Intramuscular
Meis 2003
Subtotal (95% CI )
0.erm
25 bir
[ t0.
03,
2.considered
08 ]
Prenat al adm inist9.5
rat ion%
of progest erone for prevent ing pret
h in
wom en
t o be at risk of p
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
43.1 %
0.28 [ 0.01, 5.59 ]
0.44 [ 0.17, 1.13 ]
0.38 [ 0.17, 0.87 ]
Total events: 9 (Progesterone), 15 (Placebo)
Heterogeneit y: Chi2 = 0.29, df = 2 (P = 0.86); I2 = 0.0%
Test for overall effect: Z = 2.29 (P = 0.022)
2 Vaginal
Akbari 2009
O’Brien 2007
Subtotal (95% CI )
3/69
10/72
23.3 %
6/309
7/302
16.9 %
378
374
40.2 %
0.31 [ 0.09, 1.09 ]
0.84 [ 0.28, 2.46 ]
0.53 [ 0.24, 1.18 ]
Total events: 9 (Progesterone), 17 (Placebo)
Heterogeneit y: Chi2 = 1.37, df = 1 (P = 0.24); I2 = 27%
Test for overall effect: Z = 1.55 (P = 0.12)
3 O ral
Rai 2009
3/74
7/74
74
74
16.7 %
0.43 [ 0.12, 1.59 ]
801
652
100.0 %
0.45 [ 0.27, 0.76 ]
Subtotal (95% CI )
16.7 %
0.43 [ 0.12, 1.59 ]
Total events: 3 (Progesterone), 7 (Placebo)
Heterogeneit y: not applicable
Test for overall effect: Z = 1.26 (P = 0.21)
Total (95% CI )
Total events: 21 (Progesterone), 39 (Placebo)
Heterogeneit y: Chi2 = 1.99, df = 5 (P = 0.85); I2 = 0.0%
Test for overall effect: Z = 2.99 (P = 0.0028)
Test for subgroup differences: Chi2 = 0.33, df = 2 (P = 0.85), I2 = 0.0%
0.02
0.1
Favours progesterone
1
10
50
Favour s placebo
IM progesteron kullanımı
neonatal ölüm oranında azalma RR 0.45 (0.27,0.76)
Spontan preterm doğum öyküsü
Doz ?
A nalysis 3.2.
Com par ison 3 Progest erone ver sus placebo/no t reat m ent : previous hist or y spont aneous
pret er m bir t h by cum ulat ive weekly dose ( < 500 m g v >= 500 m g, singlet ons) , O ut com e 2 Pret er m bir t h less
t han 37 weeks.
Review:
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at risThisisare
k of preterm
bir th
print of aCochra
nereview, prepared and maintained by TheCochraneCollaboration and publish
2013, Issue 7
http://www
cochra
nelibra
ry.com
3 Progesterone versus placebo/no treatment: previous histor y spontaneouspreterm bir th by cumulative weekly dose (< 500 mg v >
= 500.the
mg
, sing
letons
)
Comparison:
Outcome:
2 Preterm bir th less than 37 weeks
Study or subgroup
Progesterone
Placebo
n/N
n/N
Risk Ratio
MH,Random,95%
CI
Weight
2/18
12/25
111/306
84/153
18.2 %
16/50
30/50
13.7 %
374
228
1 Dose < 500 mg per week
J
ohnson 1975
Meis 2003
Saghafi 2011a
Subtotal (95% CI )
Risk Ratio
MH,Random,95%
CI
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk of pret er
Copyright © 20134.0
T he Cochrane
Collaborat ion. Published
by J[
ohn
W iley &
Sons, Lt
%
0.23
0.06,
0.91
] d.
36.0 %
0.66 [ 0.54, 0.81 ]
0.53 [ 0.34, 0.85 ]
0.59 [ 0.44, 0.80 ]
Total events: 129 (Progesterone), 126 (Placebo)
Heterogeneity: Tau2 = 0.03; Chi2 = 2.85, df = 2 (P = 0.24); I2 = 30%
Test for overall effect: Z = 3.40 (P = 0.00068)
2 Dose > = 500 mg per week
Akbari 2009
8/69
23/72
9.3 %
0.36 [ 0.17, 0.76 ]
Cetingoz 2011
9/37
17/34
10.4 %
0.49 [ 0.25, 0.94 ]
10/72
20/70
10.0 %
0.49 [ 0.25, 0.96 ]
Glover 2011
5/19
8/14
7.6 %
0.46 [ 0.19, 1.11 ]
Majhi 2009
6/50
19/50
8.1 %
0.32 [ 0.14, 0.72 ]
129/309
123/302
18.5 %
556
542
da Fonseca 2003
O’Brien 2007
Subtotal (95% CI )
1.03 [ 0.85, 1.24 ]
64.0 %
0.51 [ 0.31, 0.85 ]
100.0 %
0.54 [ 0.40, 0.74 ]
Total events: 167 (Progesterone), 210 (Placebo)
Heterogeneity: Tau2 = 0.29; Chi2 = 22.11, df = 5 (P = 0.00050); I2 = 77%
Test for overall effect: Z = 2.57 (P = 0.010)
Total (95% CI )
930
770
Total events: 296 (Progesterone), 336 (Placebo)
Heterogeneity:
Tau2
= 0.12;
Chi2
= 29.37, df = 8 (P = 0.00027);
I2
= 73%
Test for overall effect: Z = 3.89 (P = 0.00010)
Test for subgroup differences:
Chi2
= 0.22, df = 1 (P = 0.64),
I2
= 0.0%
0.05
0.2
1
Favours treatment
500mg/hft < veya >
plaseboya göre Etkin
5
20
Favours control
Düşük Risk Grubunda TV Cl kısa saptanan hastalarda
<37 hft doğum oranı?
Analysis 4.12.
Review:
Com parison 4 Progest erone versus placebo: ult r asound ident ified shor t cer vix, singlet ons,
O ut com e 12 Pret erm bir t h less t han 37 weeks.
Prenatal administration of progesterone for preventing preterm bir th in women considered to be aThisisare
t risk of
preterm
bir th
print
of aCochranere
view, prepared and maintained by TheCochraneCollaboration and published
2013, Issue 7
Comparison:
Outcome:
http://www.thecochranelibrary.com
4 Progesterone versus placebo: ultrasound identified shor t cervix, singletons
12 Preterm bir th less than 37 weeks
Study or subgroup
Progesterone
Placebo
n/N
n/N
Risk Ratio
Weight
M-H,Fixed,95%CI
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk of pret erm
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
1 Vaginal
Hassan 2011
Risk Ratio
M-H,Fixed,95% CI
71/235
76/223
40.3 %
0.89 [ 0.68, 1.16 ]
235
223
40.3 %
0.89 [ 0.68, 1.16 ]
82/327
80/330
41.1 %
1.03 [ 0.79, 1.35 ]
37/94
36/94
18.6 %
1.03 [ 0.72, 1.47 ]
421
424
59.7 %
1.03 [ 0.83, 1.28 ]
647
100.0 %
0.97 [ 0.82, 1.15 ]
Subtotal (95% CI )
Total events: 71 (Progesterone), 76 (Placebo)
Heterogeneity: not applicable
Test for overall effect: Z = 0.89 (P = 0.38)
2 Intramuscular
Grobman 2012
Rozenberg 2012
Subtotal (95% CI )
Total events: 119 (Progesterone), 116 (Placebo)
Heterogeneity: Chi2 = 0.00, df = 1 (P = 0.98); I2 =0.0%
Test for overall effect: Z = 0.29 (P = 0.77)
Total (95% CI )
656
Total events: 190 (Progesterone), 192 (Placebo)
Heterogeneity: Chi2 = 0.76, df = 2 (P = 0.68); I2 =0.0%
Test for overall effect: Z = 0.31 (P = 0.75)
Test for subgroup differences: Chi2 = 0.76, df = 1 (P = 0.38), I2 =0.0%
0.2
0.5
Favours progesterone
Progesteron profilaksinin etkisi yok
1
2
5
Favours placebo
Düşük Risk Grubunda TV Cl kısa saptanan hastalarda
<34 hft doğum oranı?
Analysis 4.2.
Review:
Com parison 4 Progest erone versus placebo: ultr asound identified shor t cer vix, singletons,
O ut com e 2 Pret erm bir t h less t han 34 weeks.
Thisisare
of aCochra
nere
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at risk
of print
preterm
bir
thview, prepared and maintained by TheCochraneCollaboration and publis
2013, Issue 7
http://www.thecochranelibrary.com
Comparison:
Outcome:
4 Progesterone versus placebo: ultrasound identified shor t cervix, singletons
2 Preterm bir th less than 34 weeks
Study or subgroup
Progesterone
Placebo
n/N
n/N
Risk Ratio
Weight
26/125
45/125
70.3 %
0.58 [ 0.38, 0.87 ]
125
125
70.3 %
0.58 [ 0.38, 0.87 ]
15/94
19/94
29.7 %
0.79 [ 0.43, 1.46 ]
94
94
29.7 %
0.79 [ 0.43, 1.46 ]
219
219
100.0 %
0.64 [ 0.45, 0.90 ]
M-H,Fixed,95% CI
Risk Ratio
M-H,Fixed,95% CI
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk of pret e
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
1 Vaginal
Fonesca 2007
Subtotal (95% CI )
Total events: 26 (Progesterone), 45 (Placebo)
Heterogeneity: not applicable
Test for overall effect: Z = 2.60 (P = 0.0095)
2 Intramuscular
Rozenberg 2012
Subtotal (95% CI )
Total events: 15 (Progesterone), 19 (Placebo)
Heterogeneity: not applicable
Test for overall effect: Z = 0.76 (P = 0.45)
Total (95% CI )
Total events: 41 (Progesterone), 64 (Placebo)
Heterogeneity: Chi2 = 0.68, df = 1 (P = 0.41); I2 =0.0%
Test for overall effect: Z = 2.55 (P = 0.011)
Test for subgroup differences: Chi2 = 0.68, df = 1 (P = 0.41), I2 =0.0%
0.1
0.2
0.5
Favours progesterone
1
2
5
10
Favours placebo
Vaginal Progesteron <34 hft doğum oranında azalma RR 0.58 (0.38,0.87)
Düşük Risk Grubunda TV Cl kısa saptanan hastalarda
<28 hft doğum oranı?
Analysis 4.13.
Review:
Com parison 4 Progest erone versus placebo: ultrasound identified shor t cer vix, singlet ons,
O utcom e 13 Preterm bir th less t han 28 weeks.
printbir
of aCochra
nereview, prepared and maintained by TheCochraneCollaboration and
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at risk of Thisisare
preterm
th
2013, Issue 7
http://www.thecochranelibrary.com
Comparison:
Outcome:
4 Progesterone versus placebo: ultrasound identified shor t cervix, singletons
13 Preterm bir th less than 28 weeks
Study or subgroup
Progesterone
Placebo
n/N
n/N
Risk Ratio
Weight
12/235
23/223
51.9 %
0.50 [ 0.25, 0.97 ]
235
223
51.9 %
0.50 [ 0.25, 0.97 ]
15/327
22/330
48.1 %
0.69 [ 0.36, 1.30 ]
327
330
48.1 %
0.69 [ 0.36, 1.30 ]
553
100.0 %
0.59 [ 0.37, 0.93 ]
M-H,Fixed,95% CI
Risk Ratio
M-H,Fixed,95% CI
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk o
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
1 Vaginal
Hassan 2011
Subtotal (95% CI )
Total events: 12 (Progesterone), 23 (Placebo)
Heterogeneity: not applicable
Test for overall effect: Z = 2.05 (P = 0.041)
2 Intramuscular
Grobman 2012
Subtotal (95% CI )
Total events: 15 (Progesterone), 22 (Placebo)
Heterogeneity: not applicable
Test for overall effect: Z = 1.15 (P = 0.25)
Total (95% CI )
562
Total events: 27 (Progesterone), 45 (Placebo)
Heterogeneity: Chi2 = 0.48, df = 1 (P = 0.49); I2 =0.0%
Test for overall effect: Z = 2.25 (P = 0.024)
Test for subgroup differences: Chi2 = 0.48, df = 1 (P = 0.49), I2 =0.0%
0.2
0.5
Favours progesterone
1
2
5
Favours placebo
Vaginal Progesteron <28. hft doğum oranında azalma RR 0.50 ( 0.25,0.97)
Çoğul gebeliklerde progesteron profilaksisi
Perinatal ölümler ?
A nalysis 6.1.
Review:
C om par ison 6 Progest erone ver sus placebo: m ult iple pregnancy, O ut com e 1 Per inat al deat h.
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at risk of preterm bir th
Comparison:
Outcome:
Thisisareprint of aCochranereview, prepared and maintained by TheCochraneCollaboration and publis
2013, Issue 7
http://www.thecochranelibrary.com
6 Progesterone versus placebo: multiple pregnancy
1 Perinatal death
Study or subgroup
Progesterone
Placebo
Risk Ratio
MH,Random,95%
CI
Weight
Risk Ratio
MH,Random,95%
CI
n/N
n/N
Combs 2010
19/168
2/75
Combs 2011
0/320
3/156
5.1 %
0.07 [ 0.00, 1.34 ]
4/78
2/76
11.9 %
1.95 [ 0.37, 10.33 ]
23/681
34/674
1247
981
1 Intramuscular
Har tikainen 1980
Lim 2011
Subtotal (95% CI )
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk of pret
%
4.24
[ 1.01,
Copyright © 201314.3
T he Cochrane
Collaborat ion. Published
by John
W iley & 17.75
Sons, Lt d. ]
27.0 %
58.3 %
0.67 [ 0.40, 1.12 ]
1.06 [ 0.30, 3.71 ]
Total events: 46 (Progesterone), 41 (Placebo)
Heterogeneity: Tau2 = 1.02; Chi2 = 9.42, df = 3 (P = 0.02); I2 = 68%
Test for overall effect: Z = 0.09 (P = 0.93)
2 Vaginal
Aboulghar 2012
4/98
5/84
16.0 %
0.69 [ 0.19, 2.47 ]
Rode 2011
10/664
7/678
20.3 %
1.46 [ 0.56, 3.81 ]
Serra 2013
0/194
5/190
956
952
Subtotal (95% CI )
5.3 %
0.09 [ 0.00, 1.60 ]
41.7 %
0.75 [ 0.24, 2.41 ]
100.0 %
0.93 [ 0.45, 1.94 ]
Total events: 14 (Progesterone), 17 (Placebo)
Heterogeneity: Tau2 = 0.49; Chi2 = 3.78, df = 2 (P = 0.15); I2 = 47%
Test for overall effect: Z = 0.48 (P = 0.63)
Total (95% CI )
2203
1933
Total events: 60 (Progesterone), 58 (Placebo)
Heterogeneity: Tau2 = 0.45; Chi2 = 13.01, df = 6 (P = 0.04); I2 = 54%
Test for overall effect: Z = 0.19 (P = 0.85)
Test for subgroup differences: Chi2 = 0.15, df = 1 (P = 0.70), I2 = 0.0%
0.1
0.2
0.5
Favours progesterone
1
2
5
10
Favours placebo
progesteron profilaksinin perinatal ölümler üzerinde etkisi yok
Çoğul gebeliklerde progesteron profilaksisi
<37 hft doğum?
A nalysis 6.11.
Com par ison 6 Progest erone ver sus placebo: m ult iple pregnancy, O ut com e 11 Pret er m bir t h
Thisisareprint of aCochranereview, prepared and maintained by TheCochraneCollaboration and published
less t han 37 weeks.
2013, Issue 7
Review:
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at risk of preterm bir th
Comparison:
Outcome:
http://www.thecochranelibrary.com
6 Progesterone versus placebo: multiple pregnancy
11 Preterm bir th less than 37 weeks
Study or subgroup
Progesterone
Placebo
n/N
n/N
Risk Ratio
MH,Random,95%
CI
Weight
Risk Ratio
MH,Random,95%
113/160
46/78
12.3 %
1.20 [ 0.97, 1.48 ]
15/39
9/38
1.5 %
1.62 [ 0.81, 3.25 ]
Lim 2011
186/336
165/332
19.6 %
1.11 [ 0.96, 1.29 ]
Rouse 2007
226/325
232/330
27.2 %
0.99 [ 0.89, 1.09 ]
860
778
60.6 %
1.09 [ 0.96, 1.22 ]
CI bir t h in wom en considered t o be at risk of pret erm
Prenat al adm inist rat ion of progest erone for prevent ing pret erm
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
1 Intramuscular
Combs 2011
Har tikainen 1980
Subtotal (95% CI )
Total events: 540 (Progesterone), 452 (Placebo)
Heterogeneity: Tau2 = 0.01; Chi2 = 5.20, df = 3 (P = 0.16); I2 = 42%
Test for overall effect: Z = 1.35 (P = 0.18)
2 Vaginal
Aboulghar 2012
31/49
28/42
7.0 %
0.95 [ 0.70, 1.28 ]
Cetingoz 2011
29/39
22/38
6.1 %
1.28 [ 0.93, 1.78 ]
Rode 2011
158/334
179/341
18.6 %
0.90 [ 0.77, 1.05 ]
Serra 2013
48/97
47/96
7.6 %
1.01 [ 0.76, 1.35 ]
519
517
39.4 %
0.98 [ 0.85, 1.13 ]
100.0 %
1.04 [ 0.95, 1.14 ]
Subtotal (95% CI )
Total events: 266 (Progesterone), 276 (Placebo)
Heterogeneity: Tau2 = 0.00; Chi2 = 3.85, df = 3 (P = 0.28); I2 = 22%
Test for overall effect: Z = 0.25 (P = 0.80)
Total (95% CI )
1379
1295
Total events: 806 (Progesterone), 728 (Placebo)
Heterogeneity: Tau2 = 0.00; Chi2 = 10.39, df = 7 (P = 0.17); I2 = 33%
Test for overall effect: Z = 0.91 (P = 0.36)
Test for subgroup differences: Chi2 = 1.14, df = 1 (P = 0.29), I2 = 12%
0.1
Progesteron profilaksinin
<37 hft doğumlar ETKİSİ YOK
0.2
0.5
Favours progesterone
1
2
5
10
Favours placebo
Çoğul gebeliklerde progesteron profilaksisi
<34 hft doğumlar ?
A nalysis 6.2.
Review:
C om par ison 6 Progest erone ver sus placebo: m ult iple pregnancy, O ut com e 2 Pret er m bir t h
less t han 34 weeks.
Thisisare
print of aCochra
nereview, prepared and maintained by TheCochraneCollaboration and published
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at ris
k of preterm
bir th
2013, Issue 7
Comparison:
Outcome:
http://www.thecochranelibrary.com
6 Progesterone versus placebo: multiple pregnancy
2 Preterm bir th less than 34 weeks
Study or subgroup
Progesterone
Placebo
n/N
n/N
Risk Ratio
MH,Random,95%
CI
Weight
Risk Ratio
MH,Random,95%
CI
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk of pret erm
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
1 Vaginal
Aboulghar 2012
8/49
10/42
8.7 %
0.69 [ 0.30, 1.58 ]
Cetingoz 2011
4/39
7/28
5.1 %
0.41 [ 0.13, 1.27 ]
Norman 2009
55/247
44/247
29.7 %
1.25 [ 0.88, 1.78 ]
Rode 2011
51/334
63/341
31.4 %
0.83 [ 0.59, 1.16 ]
Serra 2013
13/97
13/96
11.3 %
0.99 [ 0.48, 2.02 ]
766
754
86.2 %
0.92 [ 0.69, 1.23 ]
Subtotal (95% CI )
Total events: 131 (Progesterone), 137 (Placebo)
Heterogeneity: Tau2 = 0.03; Chi2 = 5.68, df = 4 (P = 0.22); I2 = 30%
Test for overall effect: Z = 0.59 (P = 0.56)
2 Intramuscular
Combs 2011
31/160
11/78
13.8 %
1.37 [ 0.73, 2.59 ]
160
78
13.8 %
1.37 [ 0.73, 2.59 ]
832
100.0 %
0.97 [ 0.74, 1.27 ]
Subtotal (95% CI )
Total events: 31 (Progesterone), 11 (Placebo)
Heterogeneity: not applicable
Test for overall effect: Z = 0.98 (P = 0.32)
Total (95% CI )
926
Total events: 162 (Progesterone), 148 (Placebo)
Heterogeneity: Tau2 = 0.03; Chi2 = 6.88, df = 5 (P = 0.23); I2 = 27%
Test for overall effect: Z = 0.22 (P = 0.83)
Test for subgroup differences: Chi2 = 1.30, df = 1 (P = 0.25), I2 = 23%
Progesteron profilaksinin
<34 hft doğumlar ETKİSİ YOK
0.05
0.2
Favours progesterone
1
5
20
Favours placebo
Çoğul gebeliklerde progesteron profilaksisi
28 hft doğumlar ?
A nalysis 6.12.
Review:
Com par ison 6 Progest erone ver sus placebo: m ult iple pregnancy, O ut com e 12 Pret er m bir t h
less t han 28 weeks.
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at risk of preterm bir th
Comparison:
Outcome:
Thisisareprint of aCochranereview, prepared and maintained by TheCochraneCollaboration an
2013, Issue 7
http://www.thecochranelibrary.com
6 Progesterone versus placebo: multiple pregnancy
12 Preterm bir th less than 28 weeks
Study or subgroup
Progesterone
Placebo
n/N
n/N
Risk Ratio
Weight
Combs 2010
9/56
2/25
Combs 2011
3/160
1/78
19/336
18/332
60.1 %
1.04 [ 0.56, 1.95 ]
552
435
73.7 %
1.19 [ 0.68, 2.07 ]
M-H,Fixed,95% CI
Risk Ratio
M-H,Fixed,95% CI
1 Intramuscular
Lim 2011
Subtotal (95% CI )
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
9.2 %
2.01 [ 0.47, 8.63 ]
4.5 %
1.46 [ 0.15, 13.83 ]
Total events: 31 (Progesterone), 21 (Placebo)
Heterogeneit y: Chi2 = 0.70, df = 2 (P = 0.71); I2 = 0.0%
Test for overall effect: Z = 0.61 (P = 0.54)
2 Vaginal
Rode 2011
9/334
7/341
23.0 %
1.31 [ 0.49, 3.48 ]
Serra 2013
1/97
1/96
3.3 %
0.99 [ 0.06, 15.60 ]
431
437
26.3 %
1.27 [ 0.51, 3.19 ]
872
100.0 %
1.21 [ 0.75, 1.95 ]
Subtotal (95% CI )
Total events: 10 (Progesterone), 8 (Placebo)
Heterogeneit y: Chi2 = 0.04, df = 1 (P = 0.85); I2 = 0.0%
Test for overall effect: Z = 0.51 (P = 0.61)
Total (95% CI )
983
Total events: 41 (Progesterone), 29 (Placebo)
Heterogeneit y: Chi2 = 0.76, df = 4 (P = 0.94); I2 = 0.0%
Test for overall effect: Z = 0.79 (P = 0.43)
Test for subgroup differences: Chi2 = 0.02, df = 1 (P = 0.90), I2 = 0.0%
0.01
0.1
Favours progesterone
Progesteron profilaksinin
<28 hft doğumlar ETKİSİ YOK
1
10
100
Favours placebo
Test for subgroup differences: Chi2 = 0.77, df = 2 (P = 0.68), I2 =0.0%
0.1
0.2
0.5
1
Favours progesterone
2
5
10
Favours placebo
Erken Doğum Tehdidi sonrası
profilaksi ?
Analysis 1.4.
Review:
Com parison 1 Progest erone versus placebo/no treatm ent: previous histor y spontaneous
pret erm bir t h (singlet ons), O ut com e 4 T hreat ened pret er m labour.
Thisisareprint of aCochranereview, prepared and maintained by TheCochraneCollaboration and pu
Prenatal administration of progesterone for preventing preterm bir th in women considered to be at risk
of Is
preterm
bir th
2013,
sue 7
http://www.thecochranelibrary.com
Comparison:
Outcome:
1 Progesterone versus placebo/no treatment: previous history spontaneous preterm bir th (singletons)
4 Threatened preterm labour
Study or subgroup
Progesterone
Placebo
Risk Ratio
MH,Random,95%
CI
Weight
Risk Ratio
MH,Random,95%
CI
Prenat al adm inist rat ion of progest erone for prevent ing pret erm bir t h in wom en considered t o be at risk of p
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
n/N
n/N
49/306
21/153
53.8 %
1.17 [ 0.73, 1.87 ]
306
153
53.8 %
1.17 [ 0.73, 1.87 ]
14/72
22/70
46.2 %
0.62 [ 0.35, 1.11 ]
72
70
46.2 %
0.62 [ 0.35, 1.11 ]
378
223
100.0 %
0.87 [ 0.47, 1.62 ]
1 Intramuscular
Meis 2003
Subtotal (95% CI )
Total events: 49 (Progesterone), 21 (Placebo)
Heterogeneity: not applicable
Test for overall effect: Z = 0.64 (P = 0.52)
2 Vaginal
da Fonseca 2003
Subtotal (95% CI )
Total events: 14 (Progesterone), 22 (Placebo)
Heterogeneity: not applicable
Test for overall effect: Z = 1.61 (P = 0.11)
Total (95% CI )
Total events: 63 (Progesterone), 43 (Placebo)
Heterogeneity: Tau2 = 0.13; Chi2 = 2.75, df = 1 (P = 0.10); I2 =64%
Test for overall effect: Z = 0.44 (P = 0.66)
Test for subgroup differences: Chi2 = 2.74, df = 1 (P = 0.10), I2 =63%
0.1
0.2
0.5
1
2
5
10
Erken Doğum Tehdidi sonrası progesteron profilaksisinin
ETKİSİ YOK
Favours progesterone
Favours placebo
Prenat al administ rat ion of progest erone for prevent ing pret erm bir t h in women considered t o be at risk of pret erm bir t h (Review)
Copyright © 2013 T he Cochrane Collaborat ion. Published by John W iley & Sons, Lt d.
108
Progesteron
Tipi,Dozu, ve Uygulama yolu
Tekil gebelik, spontan preterm doğum öyküsü yok
18-24 gebelik haftaları arasında TVU Servikal Uzunluk
< 20 mm
Progesteron supp. 90- 200 mg. tanıdan 36. gebelik haftasına kadar
100 mg mikronize progesteron vaginal tablet
90 mg ( %8 ) mik.progesteron vaginal gel
ACOG Practice Bulletin, Number 130, 2012
Progesteron
Tipi,Dozu, ve Uygulama yolu
Tekil gebelik, spontan preterm doğum öyküsü var
Normal Servikal Uzunluk
Hidroksiprogesteron caproat 250 mg. IM/hft 16-20. hft itibaren 36 hft kadar
Servikal Uzunluk Ölçümü 14/16. hft itibaren 24. hft kadar 2 hft aralarla
25-30mm haftada
Servikal uzunluk< 25mm , gebelik haftası< 24 hft ise
Serklaj
ACOG Practice Bulletin, Number 130, 2012
‘Prediction is the basis of
prevention’
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