Intramuscular Progesterone After PPROM in Patients with Extreme Fetal
Prematurity- A case-control pilot study
Abstract
Objective: Compare pregnancy outcomes in patients with short cervix
receiving vaginal progesterone, had preterm prelabor rupture of
membranes (PPROM) and were switched intramuscular (IM) progesterone
after PPROM, to historical data of patients with short cervix and PPROM
who did not receive IM progesterone after PPROM. Design: A retrospective
case control pilot study of singleton pregnancies complicated by short
cervix, receiving vaginal progesterone, who subsequently had PPROM, and
then switched to IM progesterone. Setting: All delivered at a regional
perinatal and tertiary referral center, between 24-34 weeks of
gestation, from January, 2015 to April, 2020. Sample: 11 singleton
pregnancies complicated by short cervix, receiving vaginal progesterone,
who subsequently had PPROM, and then switched to IM progesterone.
Methods: Maternal and neonatal outcomes included gestational age at time
of delivery, PPROM to delivery interval, chorioamnionitis, birthweight,
APGAR score <7 at 1 and 5 minutes of life, NICU admission and
significant fetal morbidity. Findings were compared to historical
control Main outcome: PPROM to delivery interval. Results: Our patient
population was significantly more premature at time of PPROM diagnosis
(mean 21.4±2.4 compared to 31.5±1.125 in the control group). The group
who received IM progesterone after PPROM had a longer PPROM to delivery
interval, higher mean birth weight. There were two cases of neonatal
death in the IM progesterone group. Conclusion: Administration of IM
progesterone supplementation in the patients with short cervix after
PPROM before 28 weeks of gestation may result in pregnancy prolongation,
especially to benefit from steroid administration to improve fetal lung
maturity.