• Roberto Romero, Kypros Nicolaides, Agustin Conde-Agudelo, Ann Tabor, John M O'Brien, Elcin Cetingoz, Eduardo Da Fonseca, George W Creasy, Katharina Klein, Line Rode, Priya Soma-Pillay, Shalini Fusey, Cetin Cam, Zarko Alfirevic, and Sonia S Hassan.
• Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA.
• Am. J. Obstet. Gynecol. 2012 Feb 1; 206 (2): 124.e1-19.

ObjectiveTo determine whether the use of vaginal progesterone in asymptomatic women with a sonographic short cervix (≤ 25 mm) in the midtrimester reduces the risk of preterm birth and improves neonatal morbidity and mortality.Study DesignIndividual patient data metaanalysis of randomized controlled trials.ResultsFive trials of high quality were included with a total of 775 women and 827 infants. Treatment with vaginal progesterone was associated with a significant reduction in the rate of preterm birth <33 weeks (relative risk [RR], 0.58; 95% confidence interval [CI], 0.42-0.80), <35 weeks (RR, 0.69; 95% CI, 0.55-0.88), and <28 weeks (RR, 0.50; 95% CI, 0.30-0.81); respiratory distress syndrome (RR, 0.48; 95% CI, 0.30-0.76); composite neonatal morbidity and mortality (RR, 0.57; 95% CI, 0.40-0.81); birthweight <1500 g (RR, 0.55; 95% CI, 0.38-0.80); admission to neonatal intensive care unit (RR, 0.75; 95% CI, 0.59-0.94); and requirement for mechanical ventilation (RR, 0.66; 95% CI, 0.44-0.98). There were no significant differences between the vaginal progesterone and placebo groups in the rate of adverse maternal events or congenital anomalies.ConclusionVaginal progesterone administration to asymptomatic women with a sonographic short cervix reduces the risk of preterm birth and neonatal morbidity and mortality.Copyright © 2012. Published by Mosby, Inc.

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