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Pregnancy Bliss | Reproductive Health Hub

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Progesterone role

What is the role of progesterone in preventing pre-term labour?

There is evidence that administration of progesterone, in the form of injection or vaginal suppositories  can help prolong pregnancy in some women prone to pre-term labour. There is strong evidence that progesterone plays an important, even essential, role in keeping the uterus in a quiescent state during pregnancy. It is with this in mind that its use to try to prevent preterm labour has been actively investigated over the years.

It is now accepted that women who have experienced previous unexplained preterm labour and/or deliveryMakena and prematurity and those known to have a short cervix (less than 1.5 cm long) can benefit from getting progesterone, typically timed in the second trimester. The exact timing of starting the treatment is still a matter of debate. However, there is solid evidence that Progesterone in the first trimester does not help in preventing miscarriage. Its role is therefore confined to the second trimester and beyond.

Another area of prevailing uncertainty is the correct dose. The trans-vaginal suppositories (pessaries) are administered at a dose of 100-200 mg every day. The injectable progesterone (17 alpha-hydroxyprogesterone caproate) is administered intramuscular at a dose of 250mg once a week. The treatment is, ideally, started at 16 weeks. There is evidence that if treatment is started later than 21 weeks, it does not confer any benefit. This is an area of pregnancy management that is likely to continue evolving.

What kind of problems does the newborn face in the short and long term?

It all depends on the degree of prematurity: the lower the gestation, the more severe the potential complications. The immediate problem the baby faces is usually respiratory.

Infant respiratory distress syndrome  (IRDS), also called "hyaline membrane disease" affects virtually all babies born before twenty-six weeks of gestation. Between 26 and 28 weeks of gestation, four out of five babies will be affected by this condition, but at thirty-two to thirty-four weeks, the figure falls to only about one in ten and tends to be less severe.

Other short-term concerns include brain haemorrhage and bowel inflammation (necrotising enterocolitis), both of which could lead to serious long-term handicap or even loss of the baby.

Long-term, there is the potential of developing chronic lung disease, eye complications (which, in some cases lead to blindness) and general or localized handicap, resulting from brain haemorrhage. Again, the risk is higher the severer the degree of prematurity.

Of all the problems mentioned, the most frequent and greatest cause of illness and infant loss is the respiratory distress syndrome.

Last update: March 26, 2013

When Makena® was licensed for use in the United States at the end of 2010, there was a lot of controversy because of what was seen as an extortionate price. The active ingredient (hydroprogesterone caproate) has been available and used for this purpose in Europe and other parts of the world for some years at a small fraction of the price

Causes Labour suppression Progesterone hormone Delivery Prematurity issues

Infant respiratory distress syndrome is the most challenging complication of severe prematurity. This baby was born at 25 weeks gestation.

Respiratory distress is the most feared complication of prematurity