TY - JOUR
T1 - Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies
T2 - a systematic review and network meta-analysis
AU - Jarde, A.
AU - Lutsiv, O.
AU - Park, C. K.
AU - Beyene, J.
AU - Dodd, J. M.
AU - Barrett, J.
AU - Shah, P. S.
AU - Cook, J. L.
AU - Saito, S.
AU - Biringer, A. B.
AU - Sabatino, L.
AU - Giglia, L.
AU - Han, Z.
AU - Staub, K.
AU - Mundle, W.
AU - Chamberlain, J.
AU - McDonald, S. D.
N1 - Publisher Copyright:
© 2017 Royal College of Obstetricians and Gynaecologists
PY - 2017/7
Y1 - 2017/7
N2 - 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.
AB - 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.
KW - Cervical cerclage
KW - cervical pessary
KW - network meta-analysis
KW - preterm birth
KW - progesterone
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85017560421&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.14624
DO - 10.1111/1471-0528.14624
M3 - 総説
C2 - 28276151
AN - SCOPUS:85017560421
SN - 1470-0328
VL - 124
SP - 1176
EP - 1189
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 8
ER -