Is there a role for progesterone in preterm labour

ABSTRACT

To evaluate the role of progesterone in combination with half the usual dose of the beta-sympathomemetic [salbutamol] in treatment of actual preterm labour and to compare it with the full dose of beta-agonist used alone. A randomized, controlled trial done at Baghdad teaching hospital and Al-Kadhimiyah teaching hospital, department of Obstetrics and Gynecology-Baghdad/Iraq, during the period from March 2006 to June 2007. One hundred one pregnant women who presented with actual preterm labour were randomly divided into two groups. Fifty-one patients received 17 hydroxyprogesterone hexanoate in oil [Primolut Depot] 250 mg with half the usual dose of salbutamol [1.25 mg/500 ml 5% dextrose] regarded as the study group and fifty patients received only salbutamol in the full dose [2.5 mg/500 ml 5% dextrose] regarded as the control group. Both groups were compared for the time of delivery within 48 hours, 48 hours - one week, and after one week, for the maternal side effects of salbutamol and progesterone and for neonatal outcome for those delivered within 1 week. There was no significant difference between the control group and the study group regarding treatment-delivery interval within 1[st] 48 hours, 48 hours - one week, and after one week [p=0.6], nor regarding neonatal death or admission to neonatal care unit [p=0.078]. Maternal side effects of beta-agonist were reduced when half the dose of salbutamol in combination with a high dose of progesterone was used. There was a highly significant reduction in tachycardia, hyperglycemia, nausea and vomiting [p=0.000], and a significant reduction in shortness of breath, restlessness, tremor and chest pain [p<0.05] in the study group compared to control group. No significant difference existed between the two groups regarding headache [p=0.93]. No pulmonary edema developed in either group. Progesterone could have a role in the treatment of actual preterm labour when used in combination with a beta-agonist to minimize the potentially life threatening side effects of beta-agonists