Progesterone Gel and Placebo were Equally Effective in Preventing Preterm Birth Among Women with Preterm Labor
Abstract Introduction The aim of this trial was to evaluate the effect of maintenance treatment with vaginal progesterone gel compared to placebo in preventing preterm birth after the onset of preterm labor.Methods A randomised controlled trial in Sweden in 2009 − 18. Women with preterm labor were randomized to daily doses of progesterone gel 90 mg (n = 29) or placebo (n = 29) after standard treatment with intravenous tocolytics. Women with intravenous tocolytics alone served as controls.Results The latency to delivery was 58 ± 34 days with progesterone and 64 ± 51 days with placebo (p = 0.83), compared to 2 ± 2 days in the control group (progesterone and placebo vs control p < 0.001). The rate of preterm birth before 34 weeks was 34 % after progesterone and 38 % after placebo (p = 0.34) compared to 100 % in the control group (p < 0.001 respectively). The composite neonatal morbidity (p = 0.65) and neonatal intensive care unit admission (p = 0.12) were comparable between the progesterone and placebo groups, but lower in these groups compared neonates of women in the control group (p < 0.001 respectively). Conclusion Maintenance treatment with progesterone gel and placebo were equally effective in preventing preterm birth among women with preterm labor. Both progesterone and placebo prolonged pregnancy more effectively than intravenous tocolysis alone. We hypothesize, that the acidic gel base reinforced the biochemical barrier at the uterine cervix, which counteracted ascending pathogen invasion and subsequent inflammation and thereby delayed preterm birth. The present results suggest, that non-hormonal agents that reinforce the biochemical cervical barrier can be useful for the prevention of preterm birth in clinical practice.