| 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 |
| Source: |
BJOG: An International Journal of Obstetrics & Gynaecology; Jul2017, Vol. 124 Issue 8, p1176-1189, 14p |
| Subject Terms: |
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 |
| Abstract: |
Background: Preterm birth (PTB) is the leading cause of infant death, but it is unclear which intervention is best to prevent it.Objectives: To compare progesterone, cerclage and pessary, determine their relative effects and rank them.Search Strategy: We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL and Web of Science (to April 2016), without restrictions, and screened references of previous reviews.Selection Criteria: We included randomised trials of progesterone, cerclage or pessary for preventing PTB in women with singleton pregnancies at risk as defined by each study.Data Collection and Analysis: 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).Main Results: 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.Conclusions: Progesterone was the best intervention for preventing PTB in singleton pregnancies at risk, reducing PTB < 34 weeks, <37 weeks, neonatal demise and other sequelae.Tweetable Abstract: Progesterone was better than cerclage and pessary to prevent preterm birth, neonatal death and more in network meta-analysis. [ABSTRACT FROM AUTHOR] |
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| Database: |
Complementary Index |
