Promising prevention of preterm labor

The authors of two recent studies related to stillbirth note that such devastating losses are associated with an increasingly high incidence of preterm labor and premature births. The results of another study this one in the American Journal of Obstetrics & Gynecology are, then, especially good news: This landmark research found that vaginal progesterone application significantly reduced the rate of preterm births in women with a short cervix a known harbinger of premature labor.

Investigators associated with the National Institutes of Health observed that they could reduce the risk of preterm labor by 42 percent with administration of progesterone intra-vaginally. This hormone is produced by the ovaries and placenta, and rises dramatically during normal pregnancy; its decline is important to the onset of labor. These results were derived from a meta-analysis of a number of different studies that had evaluated the administration of vaginal progesterone versus placebo to prevent preterm birth when a short cervix was found by ultrasound midterm in pregnancy.

Not only did the investigators observe a significant reduction in preterm birth, but they also saw a 43 percent decrease in neonatal morbidity and mortality. The administration of progesterone reduced the risk of infants respiratory distress syndrome by over half, as well as lowered the rate of a composite of other complications common to preemies. Follow-up studies up to two years later showed no adverse effects in any of the infants who had been exposed to progesterone in utero.

The results of the study, which involved investigators worldwide, are very good news. Nearly 13 million preterm births occur every year, with over 92 percent of these in developing nations. If we can make more doctors aware of this problem and its risk factors, says ACSH's Dr. Gilbert Ross, even these underdeveloped countries can begin to treat it. The main problem would be getting sophisticated ultrasound equipment out to areas without roads or even electricity.

However, ACSH s Dr. Ruth Kava points out, while sophisticated equipment might not be available, medical personnel in these areas could treat women with previous preterm labor, and that might well bring down the rates of fetal loss and damage.