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Progestogens in Preterm Labour Prevention: An Update

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Progestogens in Obstetrics and Gynecology

Abstract

Preterm births (PTBs) are among the leading cause for feto-maternal mortality and short- and long-term neonatal/infant morbidity worldwide. PTBs refer to premature deliveries occurring prior to 259 days of gestation or below 37 gestational weeks (gw). This condition is prelevant and therefore presents a major world public health problem: It has been reported that approximately 15 million preterm deliveries occurred globally in 2010, of which 1 million babies died as a result of PTB associated complications (Steer, 112:1–3, 2015). The biological basis and pathways of preterm delivery have only been partially explained. PTB is a complex syndrome and insufficient research has been performed on the etiology. Many are the possible risk factors (previous PTB, cervical effacement and dilatation, infections/inflammation being the major predisposing factors). Predictive, preventive and interventional strategies are increasing in order to manage patients at high risk for preterm delivery thus improving feto-neonatal outcomes.

Progesterone has a significant role in the maintenance of uterine quiescence (especially during the latter half of pregnancy) due to the limitation of stimulatory prostaglandin production and contraction associated protein gene expression, the suppression of the inflammatory cascade activation and thus the propagation of ascending infection, the reduction of cervical stroma degradation and gap-junction formation. Moreover, term and preterm labour onset are associated with functional withdrawal of progesterone activity at a uterine level (Martin et al., Natl Stat Rep 55:1–101, 2006). As a consequence, progesterone and other progestogens have been studied in clinical trials for preventing PTB. The characteristics of progestogens’ pharmacokinetic and pharmacodynamic profile is of great interest to researchers and clinicians in order to define the optimal drug, route of administration, dosage and exposure-response relationship.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy

    Di Renzo Gian Carlo, Tosto Valentina, Neykova Konstantsa & Giardina Irene

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  1. Di Renzo Gian Carlo
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  2. Tosto Valentina
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  3. Neykova Konstantsa
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  4. Giardina Irene
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Correspondence to Di Renzo Gian Carlo .

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Editors and Affiliations

  1. Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Howard J.A. Carp

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Carlo, D.R.G., Valentina, T., Konstantsa, N., Irene, G. (2021). Progestogens in Preterm Labour Prevention: An Update. In: Carp, H.J. (eds) Progestogens in Obstetrics and Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-030-52508-8_6

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  • DOI: https://doi.org/10.1007/978-3-030-52508-8_6

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