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Preterm Labor and Delivery pp 149–159Cite as

Progesterone

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Part of the book series: Comprehensive Gynecology and Obstetrics ((CGO))

Abstract

Progesterone has been widely used for the prevention of preterm births (PTBs). However, progesterone supplement therapy is considered ineffective for women in preterm labor diagnosed strictly with regular uterine contractions and cervical ripening.

Recent studies have shown that the efficacy of progesterone therapy for preventing PTB may depend on the administration route, type of supplementation, and indication.

First, a detailed medical history should be taken regarding the existence of a prior spontaneous singleton PTB. If a prior singleton PTB is noted, weekly intramuscular (IM) injections of 250 mg of 17-alpha-hydroxyprogesterone caproate (17α-OHPC) from 16 to 20 weeks’ gestation until 36 weeks’ gestation should be recommended.

Universal screening with transvaginal ultrasonography to detect the cervical length (CL) at 18–24 weeks should be offered to all pregnant women without a prior PTB. If the CL is less than 25 mm, the daily administration of a vaginal progesterone suppository (200 mg) until 36 weeks’ gestation should be recommended.

In multifetal pregnancies, the administration of progesterone (either IM or vaginal) does not appear to reduce the incidence of PTB or improve neonatal outcomes. However, in twin pregnancies with a short cervix, vaginal progesterone supplement therapy may be effective in reducing the rate of PTB and improving neonatal outcomes.

According to the Japan health insurance system, 17α-OHPC injections can be used weekly to treat threatened abortion or preterm labor, at a maximum dose of 125 mg, whereas a natural micronized vaginal progesterone suppository can be used to legally treat infertile patients; however, this treatment is not covered by the health insurance for PTB prevention.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, Japan

    Keiya Fujimori M.D., Ph.D., Hyo Kyozuka M.D., Ph.D. & Shun Yasuda M.D., Ph.D.

Authors
  1. Keiya Fujimori M.D., Ph.D.
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  2. Hyo Kyozuka M.D., Ph.D.
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  3. Shun Yasuda M.D., Ph.D.
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Correspondence to Keiya Fujimori M.D., Ph.D. .

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Editors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Miyazaki, Faculty of Medicine, Miyazaki, Japan

    Hiroshi Sameshima

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Fujimori, K., Kyozuka, H., Yasuda, S. (2020). Progesterone. In: Sameshima, H. (eds) Preterm Labor and Delivery. Comprehensive Gynecology and Obstetrics. Springer, Singapore. https://doi.org/10.1007/978-981-13-9875-9_15

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  • DOI: https://doi.org/10.1007/978-981-13-9875-9_15

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  • Online ISBN: 978-981-13-9875-9

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