ROLE OF VAGINAL PROGESTERONE IN THE PREVENTION OF PRETERM DELIVERY

BACKGROUND Preterm Birth is the main cause  of   Perinatal morbidity and Mortality. Progesterone has been used  for preventing Preterm Labour  and is being  advocated for it. Its  use  in women presenting  with Preterm labor  pains has diverse results.The administration  of Progesterone has been shown to lower  not only  the number of  the episodes of  preterm Uterine contractions but it also decrease  the  incidence   of preterm delivery in the high  risk  women for Preterm delivery.  OBJECTIVE To compare the frequency of Spontaneous Preterm Birth , in the woman having a  prior history of one spontaneous Preterm Delivery, who are treated by 100mg of vaginal progesterone pessary daily versus controls. STUDY DESIGN  A Randomized controlled trial  was carried out at the Obstetrics & Gynaecology Department  of Lahore General Hospital (a tertiary care hospital) of 6 months duration from 1-09-2018 To 28-02-2019. Two groups of Patients were made. Patients in Group-A were instructed to use a vaginal pessary containing 100mg natural progesterone daily before going to sleep every night, starting from the time of enrollment to 36 weeks of pregnancy or until occurrence of preterm labor or premature rupture of membranes.  Patients in Group-B did not receive progesterone pessary and acted as control.All the patient were followed up until  the delivery.  RESULTS In Group :A and in Group:B mean age of  the women was 27.71±3.31 and 27.81±3.57 years. There were total 60(30%) neonates who were  delivered  premature. In Group-A, the frequency of preterm delivery was 21%(21/100), while in Group-B it was 39%. The  frequency of the Preterm delivery was quite significantly less in the women who were on progesterone as compared to the women who were not given progesterone. i.e. (p-value=0.005) CONCLUSION It is thus concluded that  vaginal  progesterone resulted in Significant reduction of  the Preterm delivery rate in the  women with a prior history of  1 spontaneous Preterm birth i.e. 21% in treatment group A vs. 39% in non-treatment group B.