{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T12:22:39Z","timestamp":1793017359889,"version":"4.5.0"},"reference-count":72,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,3,6]],"date-time":"2017-03-06T00:00:00Z","timestamp":1488758400000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the efficacy of vaginal progesterone for the prevention of preterm birth and neonatal morbidity and mortality in asymptomatic women with a twin gestation and a sonographic short cervix (cervical length \u2264 25 mm) in the mid\u2010trimester.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was an updated systematic review and meta\u2010analysis of individual patient data (IPD) from randomized controlled trials comparing vaginal progesterone with placebo\/no treatment in women with a twin gestation and a mid\u2010trimester sonographic cervical length \u2264 25 mm. MEDLINE, EMBASE, POPLINE, CINAHL and LILACS (all from inception to 31 December 2016), the Cochrane Central Register of Controlled Trials, Research Registers of ongoing trials, Google Scholar, conference proceedings and reference lists of identified studies were searched. The primary outcome measure was preterm birth &lt; 33 weeks' gestation. Two reviewers independently selected studies, assessed the risk of bias and extracted the data. Pooled relative risks (RRs) with 95% confidence intervals (CI) were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      IPD were available for 303 women (159 assigned to vaginal progesterone and 144 assigned to placebo\/no treatment) and their 606 fetuses\/infants from six randomized controlled trials. One study, which included women with a cervical length between 20 and 25 mm, provided 74% of the total sample size of the IPD meta\u2010analysis. Vaginal progesterone, compared with placebo\/no treatment, was associated with a statistically significant reduction in the risk of preterm birth &lt; 33 weeks' gestation (31.4%\n                      <jats:italic>vs<\/jats:italic>\n                      43.1%; RR, 0.69 (95% CI, 0.51\u20130.93); moderate\u2010quality evidence). Moreover, vaginal progesterone administration was associated with a significant decrease in the risk of preterm birth &lt; 35, &lt; 34, &lt; 32 and &lt; 30 weeks' gestation (RRs ranging from 0.47 to 0.83), neonatal death (RR, 0.53 (95% CI, 0.35\u20130.81)), respiratory distress syndrome (RR, 0.70 (95% CI, 0.56\u20130.89)), composite neonatal morbidity and mortality (RR, 0.61 (95% CI, 0.34\u20130.98)), use of mechanical ventilation (RR, 0.54 (95% CI, 0.36\u20130.81)) and birth weight &lt; 1500 g (RR, 0.53 (95% CI, 0.35\u20130.80)) (all moderate\u2010quality evidence). There were no significant differences in neurodevelopmental outcomes at 4\u20135 years of age between the vaginal progesterone and placebo groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Administration of vaginal progesterone to asymptomatic women with a twin gestation and a sonographic short cervix in the mid\u2010trimester reduces the risk of preterm birth occurring at &lt; 30 to &lt; 35 gestational weeks, neonatal mortality and some measures of neonatal morbidity, without any demonstrable deleterious effects on childhood neurodevelopment. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.17397","type":"journal-article","created":{"date-parts":[[2017,1,9]],"date-time":"2017-01-09T02:22:49Z","timestamp":1483928569000},"page":"303-314","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":182,"title":["Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta\u2010analysis of individual patient data"],"prefix":"10.1002","volume":"49","author":[{"given":"R.","family":"Romero","sequence":"first","affiliation":[{"name":"Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services  Bethesda, MD and Detroit MI USA"},{"name":"Department of Obstetrics and Gynecology University of Michigan  Ann Arbor MI USA"},{"name":"Department of Epidemiology and Biostatistics Michigan State University  East Lansing MI USA"},{"name":"Center for Molecular Medicine and Genetics Wayne State University  Detroit MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Conde\u2010Agudelo","sequence":"additional","affiliation":[{"name":"Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services  Bethesda, MD and Detroit MI USA"},{"name":"Department of Obstetrics and Gynecology Wayne State University School of Medicine  Detroit MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"El\u2010Refaie","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mansoura University Hospitals Mansoura University  Mansoura Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Rode","sequence":"additional","affiliation":[{"name":"Center of Fetal Medicine and Pregnancy, Department of Obstetrics Copenhagen University Hospital  Rigshospitalet Copenhagen Denmark"},{"name":"Department of Clinical Biochemistry Herlev and Gentofte Hospital  Herlev Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. L.","family":"Brizot","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology S\u00e3o Paulo University Medical School  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Cetingoz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Zeynep Kamil Women and Children Diseases Education and Research Hospital  Uskudar Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Serra","sequence":"additional","affiliation":[{"name":"Maternal\u2010Fetal Medicine Unit, Instituto Valenciano de Infertilidad University of Valencia  Valencia Spain"},{"name":"Department of Pediatrics, Obstetrics and Gynecology University of Valencia  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Da Fonseca","sequence":"additional","affiliation":[{"name":"Departamento de Obstetr\u00edcia e Ginecologia, Hospital do Servidor Publico Estadual \u2018Francisco Morato de Oliveira\u2019 and School of Medicine University of S\u00e3o Paulo  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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