Progesterone to prevent preterm labor

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I am a nursing student and am in the middle of an evidence based practice paper regarding the use of progesterone to prevent preterm labor (third trimester). I've done my research, but need an opinion by an expert nurse. Any one have experience with it? In what form (IM, lady partsl suppository, other)? Did the patient get to term? Side effects?

Thanks for your help!

Araminha

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Specializes in High Risk In Patient OB/GYN.

To be honest, I've never seen this used in the way you describe (that is, 3rd trimester to prevent PTL).

Sounds like it might be a better (safer) choice than Mag though....if it were effective.

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Specializes in OB/GYN.

The only progesterone I know about for PTL is 17-P. It stands for 17 alpha-hydroxyprogesterone. It is given to women with a history of pre-term birth not pre-term labor. It's an injection that is started at 15-16 weeks gestation. They get 250mg IM weekly. It's stopped at 35 weeks.

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Specializes in Geriatrics, Cardiac, ICU.

Has anyone ever thought to check a woman's progesterone levels when she was in PTL? The way we are learning it, progesterone = progestation.

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Specializes in Maternal - Child Health.
Has anyone ever thought to check a woman's progesterone levels when she was in PTL? The way we are learning it, progesterone = progestation.

Abnormally low levels of progesterone can predispose a woman to early miscarriage. It is common practice to check progesterone levels weekly in women with a known risk, then prescribe progesterone suppositories tailor-made to correct the patient's deficiency. This continues into the second trimester.

I have read about the use of progesterone injections for preterm labor in the third trimester, but have not seen it used, either from a patient's or nurse's standpoint. I WISH I had been able to try it myself, as I spent most of the third trimesters of my pregnancies on MgSO4. Not pleasant.

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Specializes in Geriatrics, Cardiac, ICU.
Abnormally low levels of progesterone can predispose a woman to early miscarriage. It is common practice to check progesterone levels weekly in women with a known risk, then prescribe progesterone suppositories tailor-made to correct the patient's deficiency. This continues into the second trimester.

I have read about the use of progesterone injections for preterm labor in the third trimester, but have not seen it used, either from a patient's or nurse's standpoint. I WISH I had been able to try it myself, as I spent most of the third trimesters of my pregnancies on MgSO4. Not pleasant.

Thanks! They should research this more. It seems like there is some hormone out of whack and the solution would be to correct that.

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It's been studies and doesn't work, according to one of my midwifery texts. I'd have to dig up the research though. It does make sense that it would work, but apparently it doesn't.

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The only progesterone I know about for PTL is 17-P. It stands for 17 alpha-hydroxyprogesterone. It is given to women with a history of pre-term birth not pre-term labor. It's an injection that is started at 15-16 weeks gestation. They get 250mg IM weekly. It's stopped at 35 weeks.

Thanks for reminding about the distinction between pre-term birth and pre-term labor--it's best not to get sloppy with language.

Do you have personal experience with 17-P? If so, did it seem to do work?

Araminha

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It's been studies and doesn't work, according to one of my midwifery texts. I'd have to dig up the research though. It does make sense that it would work, but apparently it doesn't.

To save you time: I've found two critical reviews of studies that were done. Both found that both IM injections of 17-P and a lady partsl gel form to be helpful. Neither found any significant risk to either baby or mother. One study was wildly enthusiastic about using progesterone to prevent preterm birth--and essentially said to not use it would be "likely to cause untold harm, similar to the harm caused by the delay in the introduction of streptokinase therapy after myocardial infarction, or steroids in preterm birth." The other was more cautious because they feel not enough studies have been done and worry about the possibility of long term reproductive damage like what was found with DES.

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Specializes in Perinatal, Education.

My hospital is currently doing a study on this. It is double blind, so I won't have info until it is finished!

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Specializes in OB/GYN.

The perinatoligists where I did my midwifery clinicals all used it. I don't know the statistics on efficacy but they seemed to think it worked.

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