Comparison of Efficacy of Vaginal and Intramuscular Progesterone in Preventing Preterm Birth in High-Risk Pregnant Women

Hina; Zaib Un Nisa; Zeenat Un Nisa; Shams Un Nisa; Roona Khan

doi:10.70749/ijbr.v2i02.389

Authors

Hina Gynae Unit-III, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Zaib Un Nisa Gynae Unit-III, Bolan Medical College, Quetta, Balochistan, Pakistan.
Zeenat Un Nisa Obstetrics & Gynaecology Department, Bolan Medical College, Quetta, Balochistan, Pakistan.
Shams Un Nisa Obstetrics & Gynaecology Department, Bolan Medical College, Quetta, Balochistan, Pakistan.
Roona Khan Bolan Medical College/ Sademan Provincial Hospital, Quetta, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v2i02.389

Keywords:

Preterm Birth, Premature Birth, Pregnancy, High-Risk, Progesterone, Hydroxyprogestins, Drug, Administration Routes, Intramuscular Injections, Vaginal Administration

Abstract

Objective: To compare the efficacy of vaginal and intramuscular progesterone in preventing preterm birth among high-risk pregnant women. Material and Methods: This cross-sectional study included 100 high-risk pregnant women at gestational ages <37 weeks. Participants were randomly assigned to receive either 200 mg daily vaginal progesterone suppositories (Group A) or 250 mg weekly intramuscular 17α-hydroxyprogesterone injections (Group B). Outcomes measured included gestational age at delivery, NICU admissions, APGAR scores, birth weight, and adverse effects. Data were analyzed using SPSS version 25, with statistical significance set at p≤0.05. Results: Group A showed 84% deliveries >37 weeks, compared to 86% in Group B (p>0.05). Normal deliveries were observed in 80% of Group A and 84% of Group B. NICU admissions occurred in 16% of Group A and 12% of Group B. Abnormal APGAR scores were reported in 14% of Group A and 4% of Group B. Both groups demonstrated comparable safety and efficacy. Conclusion: Vaginal and intramuscular progesterone exhibited similar efficacy in preventing preterm birth. Vaginal progesterone showed marginal advantages in neonatal outcomes and fewer systemic side effects.

Downloads

Download data is not yet available.

References

James , D., Steer , P., Weiner , C., Gonik , B., & Robson , S. (2017). High-Risk Pregnancy. Cambridge University Press EBooks. https://doi.org/10.1017/9781108349185

Medeiros, A. L. de, Santos, S. R. dos, Cabral, R. W. de L., Silva, J. P. G., Nascimento, N. de M., Medeiros, A. L. de, Santos, S. R. dos, Cabral, R. W. de L., Silva, J. P. G., & Nascimento, N. de M. (2016). Assessing nursing diagnoses and interventions in labour and high-risk pregnancies. Revista Gaúcha de Enfermagem, 37(3). https://doi.org/10.1590/1983-1447.2016.03.55316

Rodrigues, P. B., Zambaldi, C. F., Cantilino, A., & Sougey, E. B. (2016). Special features of high-risk pregnancies as factors in development of mental distress: a review. Trends in Psychiatry and Psychotherapy, 38(3), 136–140. https://doi.org/10.1590/2237-6089-2015-0067

Khadivzadeh, T., Abdollahpour, S., Heydari, A., Ebrahimipour, H., & Faridhosseini, F. (2019). The needs of women who have experienced “maternal near miss“: A systematic review of literature. Iranian Journal of Nursing and Midwifery Research, 24(6), 417. https://doi.org/10.4103/ijnmr.ijnmr_77_19

MANUCK, T. A., RICE, M. M., BAILIT, J. L., GROBMAN, W. A., REDDY, U. M., WAPNER, R. J., THORP, J. M., CARITIS, S. N., PRASAD, M., TITA, A. T. N., SAADE, G. R., SOROKIN, Y., ROUSE, D. J., BLACKWELL, S. C., & TOLOSA, J. E. (2016). Preterm Neonatal Morbidity and Mortality by Gestational Age: A Contemporary Cohort. American Journal of Obstetrics and Gynecology, 215(1), 103.e1–103.e14. https://doi.org/10.1016/j.ajog.2016.01.004

Chen, K., Chen, I., Yang, Y., & Chen, K. (2019). The trends and associated factors of preterm deliveries from 2001 to 2011 in Taiwan. Medicine, 98(13), e15060. https://doi.org/10.1097/md.0000000000015060

Shabaan, O. M., Hassanin, I. M., Makhlouf, A. M., Salem, M. N., Hussein, M., Mohamed, M., & Abbas, A. M. (2018). Vaginal progesterone for prevention of preterm delivery in women with twin pregnancy: a randomized controlled trial. PubMed, 10(2), 93–98.

Van Zijl, M., Koullali, B., Mol, B. W., Pajkrt, E., & Oudijk, M. (2016). Prevention of preterm delivery: Current challenges and future prospects. International Journal of Women's Health, 8, 633-645. https://doi.org/10.2147/ijwh.s89317

Abdelaziz, M. (2018). Oral versus vaginal progesterone in preterm labor. Evidence Based Women's Health Journal, 0(0), 141-149. https://doi.org/10.21608/ebwhj.2018.5580

Choi, S., Kwak, D., Kil, K., Kim, S., Kwon, J., Kim, Y., Na, S., Bae, J., Cha, H., Shim, J., Oh, K., Lee, K., Kim, S., Cho, I., Lee, S., Cho, G., Jo, Y., Choi, G., & Choi, S. (2020). Vaginal compared with intramuscular progestogen for preventing preterm birth in high‐risk pregnant women (Victoria study): A multicentre, open‐label randomised trial and meta‐analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 127(13), 1646-1654. https://doi.org/10.1111/1471-0528.16365

Meis, P. J., Klebanoff, M., Thom, E., Dombrowski, M. P., Sibai, B., Moawad, A. H., Spong, C. Y., Hauth, J. C., Miodovnik, M., Varner, M. W., Leveno, K. J., Caritis, S. N., Iams, J. D., Wapner, R. J., Conway, D., O'Sullivan, M. J., Carpenter, M., Mercer, B., Ramin, S. M., … Gabbe, S. (2003). Prevention of recurrent preterm delivery by 17 Alpha-hydroxyprogesterone caproate. New England Journal of Medicine, 348(24), 2379-2385. https://doi.org/10.1056/nejmoa035140

Hassan, S. S., Romero, R., Vidyadhari, D., Fusey, S., Baxter, J. K., Khandelwal, M., Vijayaraghavan, J., Trivedi, Y., Soma‐Pillay, P., Sambarey, P., Dayal, A., Potapov, V., O'Brien, J., Astakhov, V., Yuzko, O., Kinzler, W., Dattel, B., Sehdev, H., & Mazheika, L. (2011). Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: A multicenter, randomized, double‐blind, placebo‐controlled trial. Ultrasound in Obstetrics & Gynecology, 38(1), 18-31. https://doi.org/10.1002/uog.9017

MAHER, M. A., ABDELAZIZ, A., ELLAITHY, M., & BAZEED, M. F. (2012). Prevention of preterm birth: A randomized trial of vaginal compared with intramuscular progesterone. Acta Obstetricia et Gynecologica Scandinavica, 92(2), 215-222. https://doi.org/10.1111/aogs.12017

Berghella, V., Figueroa, D., Szychowski, J. M., Owen, J., Hankins, G. D., Iams, J. D., Sheffield, J. S., Perez-Delboy, A., Wing, D. A., & Guzman, E. R. (2010). 17-alpha-hydroxyprogesterone caproate for the prevention of preterm birth in women with prior preterm birth and a short cervical length. American Journal of Obstetrics and Gynecology, 202(4), 351.e1-351.e6. https://doi.org/10.1016/j.ajog.2010.02.019

Khandelwal, M. (2012). Vaginal progesterone in risk reduction of preterm birth in women with short cervix in the midtrimester of pregnancy. International Journal of Women's Health, 481. https://doi.org/10.2147/ijwh.s28944

Lorillon, M., Robin, G., Keller, L., Cailliau, E., Delcourt, C., Simon, V., Decanter, C., & Catteau-Jonard, S. (2024). Is oral dydrogesterone equivalent to vaginal micronized progesterone for luteal phase support in women receiving oocyte donation? Reproductive Biology and Endocrinology, 22(1). https://doi.org/10.1186/s12958-024-01322-7

Shaik, I. H., Chaphekar, N., Vasudevan, V., Alshabi, A., AlOwaifeer, A., Zhao, W., Caritis, S., & Venkataramanan, R. (2024). Vaginal administration of 17-alpha hydroxyprogesterone caproate appears to be safe in non-pregnant female rats and rabbits. Xenobiotica, 54(10), 821-830. https://doi.org/10.1080/00498254.2024.2432900

Tehraninejad, E. S., Alizadeh, S., Nekoo, E. A., Zargarzadeh, N., Shariat, M., Haghollahi, F., Tarafdari, A., & Parsaei, M. (2024). Comparing the outcomes of in-vitro fertilization in patients receiving vaginal, subcutaneous, and intramuscular progesterone for luteal phase support: A three-armed randomized controlled trial. BMC Women's Health, 24(1). https://doi.org/10.1186/s12905-024-03337-z

Zhang, J., Sun, S., Bai, X., Yang, N., Liu, Y., Wu, X., & Li, X. (2024). Metabolomics analysis of the effect of GnRH on the pregnancy rate of ewes with estrus synchronization scheme based on progesterone. Frontiers in Veterinary Science, 11. https://doi.org/10.3389/fvets.2024.1442931

Zhao, H., He, W., Xia, C., & Yang, Z. (2024). Efficacy and safety of different progestogens in women with first threatened miscarriage: A network meta‐analysis. International Journal of Gynecology & Obstetrics. https://doi.org/10.1002/ijgo.15987