Efficacy of intramuscular progesterone in prevention of preterm birth in patients with history of preterm birth

Khadija Shahzad, Tazeen Farhan, Sadia Ilyas


Background: Preterm birth is associated with many adverse outcomes and is defined as birth of a baby before 37 weeks of gestation. Around 15 million babies born preterm around the world with survival rates at different gestational like less 23 week, 23 weeks, 24 weeks and 25 weeks are 0%, 15%, 55% and 80% respectively. Progesterone has shown to reduce the incidence of preterm birth. Objective of the study was to find out frequency of preterm birth in patients (with previous history of preterm birth) treated with intramuscular progesterone.

Methods: It was randomized controlled trial conducted in the department of Obstetrics and Gynecology, Unit-I, Sir Ganga Ram Hospital Lahore, Pakistan conducted from October 2017 to April 2018. It included 530 pregnant women with history of at least 1 previous preterm delivery presenting in antenatal clinic between 16-20 weeks of gestation. The lottery method was employed to segregate patients in two groups. Patients received intramuscular progesterone injection proluton depot 250 mg intramuscular weekly from 16-20 weeks till 37 weeks and other group received placebo drug.

Results: Mean age was 27.52±4.57 years while the mean gestational age was 17.39±1.38 weeks. The mean gestational age at delivery was significantly higher among intramuscular group (36.14±2.23 versus 35.07±2.97 weeks; p=0.000). The frequency of preterm delivery was significantly lower in intramuscular group (24.9% versus 39.6%; p=0.000) as compared to placebo group.

Conclusions: Frequency of preterm delivery was significantly lower in patients treated with intramuscular progesterone (24.9% versus 39.6%; p=0.000) irrespective of patients age, parity, BMI and number of previous preterm deliveries. 


Efficacy, Intramuscular progesterone, Preterm delivery, Prevention

Full Text:



Seol HJ, Choi SJ, Oh SY. Progesterone treatment for prevention of preterm birth. Perinatology. 2016;27(4):205-15.

Ibrahim M, Ramy AR, Younis MA. Progesterone supplementation for prevention of preterm labour: a randomized controlled trial. Middle East Fert Soc J. 2010;15(1):39-41.

Kuon RJ, Voß P, Rath W. Progesterone for the prevention of preterm birth- an update of evidence-based indications. Obstet Gynecol. 2019;79(08):844-53.

Wajid R, Zafar M, Waheed F. Effectiveness of vaginal versus intramuscular progesterone for the prevention of preterm delivery. Ann King Edward Med Univ. 2016;22(4):284-9.

Kim YJ. Progesterone treatment for the prevention of preterm birth. J Korean Med Assoc. 2016;59(4):319-25.

Choi SJ. Use of progesterone supplement therapy for prevention of preterm birth: review of literatures. Obstet Gynecol Sci. 2017;60(5):405-20.

Darwish AM, Ismail AE, Mohammad MS, Gobara SA. Oral micronized or parenteral progesterone versus health education in the prevention of preterm birth: A single blinded randomized controlled trial. Open J Obstet Gynecol. 2019;9(5):612-23.

Do SC, Yeaton-Massey A, Judy AE, O'Malley K, Moore GS. Effectiveness of intramuscular progesterone for the prevention of preterm birth in twin pregnancies based on body mass index. Am J Obstet Gynecol. 2016;214(1):333-4.

Sykes L, Bennett PR. Efficacy of progesterone for prevention of preterm birth. Best Pract Res Clin Obstet Gynaecol. 2018;52:126-36.

Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008;371(9608):261-9.

Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo JH, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. World Health Bull. 2010;88(1):31-8.

Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health. 2013;10(1):2.

Rai P, Rajaram S, Goel N, Ayalur Gopalakrishnan R, Agarwal R, Mehta S. Oral micronized progesterone for prevention of preterm birth. Int J Gynaecol Obstet. 2009;104(1):40-3.

Glover MM, McKenna DS, Downing CM, Smith DB, Croom CS, Sonek JD. A randomized trial of micronized progesterone for the prevention of recurrent preterm birth. Am J Perinatol. 2011;28(5):377-81.

Hameed AA. Vaginal versus intramuscular progesterone in the prevention of preterm labor and their effect on uterine and fetal blood flow. Middle East Fertil Soc J. 2012;17:163-9.

Berghella V, Figueroa D, Szychowski JM, Owen J, Hankins GD, Iams JD, et al. 17 alpha-hydroxyprogesterone caproate for the prevention of preterm birth in women with prior preterm birth and a short cervical length. Am J Obstet Gynecol. 2010;202(4):1-6.

Choudhary M, Suneja A, Vaid NB, Guleria K, Faridi MM. Maintenance tocolysis with oral micronized progesterone for prevention of preterm birth after arrested preterm labor. Int J Gynaecol Obstet. 2014;126(1):60-3.

Grobman WA, Thom EA, Spong CY, Iams JD, Saade GR, Mercer BM, et al. 17 alpha-hydroxyprogesterone caproate to prevent prematurity in nulliparas with cervical length less than 30 mm. Am J Obstet Gynecol. 2012;207(5):1-8.