We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta-analysis.
- Authors
Jarde, A; Lutsiv, O; Park, CK; Beyene, J; Dodd, JM; Barrett, J; Shah, PS; Cook, JL; Saito, S; Biringer, AB; Sabatino, L; Giglia, L; Han, Z; Staub, K; Mundle, W; Chamberlain, J; McDonald, SD; Park, C K; Dodd, J M; Shah, P S
- Abstract
<bold>Background: </bold>Preterm birth (PTB) is the leading cause of infant death, but it is unclear which intervention is best to prevent it.<bold>Objectives: </bold>To compare progesterone, cerclage and pessary, determine their relative effects and rank them.<bold>Search Strategy: </bold>We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL and Web of Science (to April 2016), without restrictions, and screened references of previous reviews.<bold>Selection Criteria: </bold>We included randomised trials of progesterone, cerclage or pessary for preventing PTB in women with singleton pregnancies at risk as defined by each study.<bold>Data Collection and Analysis: </bold>We extracted data by duplicate using a piloted form and performed Bayesian random-effects network meta-analyses and pairwise meta-analyses. We rated evidence quality using GRADE, ranked interventions using SUCRA and calculated numbers needed to treat (NNT).<bold>Main Results: </bold>We included 36 trials (9425 women; 25 low risk of bias trials). Progesterone ranked first or second for most outcomes, reducing PTB < 34 weeks [odds ratio (OR) 0.44; 95% credible interval (CrI) 0.22-0.79; NNT 9; low quality], <37 weeks (OR 0.58; 95% CrI 0.41-0.79; NNT 9; moderate quality), and neonatal death (OR 0.50; 95% CrI 0.28-0.85; NNT 35; high quality), compared with control, in women overall at risk. We found similar results in the subgroup with previous PTB, but only a reduction of PTB < 34 weeks in women with a short cervix. Pessary showed inconsistent benefit and cerclage did not reduce PTB < 37 or <34 weeks.<bold>Conclusions: </bold>Progesterone was the best intervention for preventing PTB in singleton pregnancies at risk, reducing PTB < 34 weeks, <37 weeks, neonatal demise and other sequelae.<bold>Tweetable Abstract: </bold>Progesterone was better than cerclage and pessary to prevent preterm birth, neonatal death and more in network meta-analysis.
- Subjects
PREMATURE labor prevention; PREGNANCY; PROGESTERONE; CERVICAL cerclage; META-analysis; PHYSIOLOGY; GESTATIONAL age; PESSARIES; PREMATURE infants; PROBABILITY theory; PROGESTATIONAL hormones; VAGINAL medication; SYSTEMATIC reviews; TREATMENT effectiveness; PREVENTION
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2017, Vol 124, Issue 8, p1176
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.14624