Progesterone, cerclage, pessary, or acetylsalicylic acid for prevention of preterm birth in singleton and multifetal pregnancies

Ljungström E, Möller AC, Bergman L, Ekelund AC, Hongslo Vala C, Jacobsson B, Kuusela P, Liljegren A, Petzold M, Sjögren P, Svensson M, Wennerholm UB, Strandell A
Record ID 32018011369
Authors' objectives: Background Preterm birth is the leading cause of child mortality and morbidity, both short-term complications and long-term neurodevelopmental impairment, globally. Preterm birth is defined as follows: extremely preterm (<28 weeks), very preterm (28 to 32 weeks), and moderate to late preterm (32 to 37 weeks). Any preterm birth comprises spontaneous (approximately 2/3) and indicated preterm birth (1/3), the latter due to maternal or fetal complications. Spontaneous preterm birth has a multifactorial aetiology. Risk factors include previous spontaneous preterm birth, late miscarriage, cervical surgery, short cervical length, and multifetal pregnancy. The preterm birth rate <37 weeks in Sweden during 2020 was 5.3%. There is presently no national guideline in Sweden concerning screening and prevention of preterm birth. Question at issue Will the interventions progesterone, cerclage, pessary, or acetylsalicylic acid (ASA), alone or in combinations, decrease the risk of preterm birth and neonatal and maternal mortality/morbidity, and long-term child morbidity in asymptomatic women with a singleton pregnancy at risk of preterm birth or in asymptomatic women with a multifetal pregnancy with or without additional risk factor(s),in comparison with no or any of the above-mentioned interventions?
Authors' results and conclusions: Progesterone compared with placebo in singleton pregnancies with increased risk of preterm birth, reduces the risk of any preterm birth, thereby reducing neonatal mortality and respiratory distress syndrome. In multifetal pregnancies the effect of progesterone is very limited, if any. Cerclage in singleton pregnancies probably reduces the risk of any preterm birth and perinatal mortality. Pessary did not demonstrate any overall effect. ASA in singleton pregnancies did not affect any outcome. Prevention of preterm birth would require screening programmes to identify women at risk of preterm birth.
Project Status: Completed
Year Published: 2022
English language abstract: An English language summary is available
Publication Type: Full HTA
MeSH Terms
  • Premature Birth
  • Progesterone
  • Cerclage, Cervical
  • Pessaries
  • Aspirin
  • Pregnancy Complications
  • Pregnancy
  • Pregnancy Outcome
  • Pregnancy, Multiple
Organisation Name: The Regional Health Technology Assessment Centre
Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden
Contact Name:
Contact Email:
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.