{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T07:03:39Z","timestamp":1790406219826,"version":"4.1.0"},"reference-count":56,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,12,29]],"date-time":"2018-12-29T00:00:00Z","timestamp":1546041600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["950\u2010229920"],"award-info":[{"award-number":["950\u2010229920"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Recent progesterone trials call for an update of previous syntheses of interventions to prevent preterm birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To compare the relative effects of different types and routes of administration of progesterone, cerclage, and pessary at preventing preterm birth in at\u2010risk women overall and in specific populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL, and Web of Science up to 1 January 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection criteria<\/jats:title><jats:p>We included randomised trials of progesterone, cerclage or pessary for preventing preterm birth in at\u2010risk singleton pregnancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>We used a piloted data extraction form and performed Bayesian random\u2010effects network meta\u2010analyses with 95% credibility intervals (CrI), as well as pairwise meta\u2010analyses, rating the quality of the evidence using GRADE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>We included 40 trials (11 311 women). In at\u2010risk women overall, vaginal progesterone reduced preterm birth &lt;34 (OR 0.43, 95% CrI 0.20\u20130.81) and &lt;37 weeks (OR 0.51, 95% CrI 0.34\u20130.74), and neonatal death (OR 0.41, 95% CrI 0.20\u20130.83). In women with a previous preterm birth, vaginal progesterone reduced preterm birth &lt;34 (OR 0.29, 95% CI 0.12\u20130.68) and &lt;37 weeks (OR 0.43, 95% CrI 0.23\u20130.74), and 17\u03b1\u2010hydroxyprogesterone caproate reduced preterm birth &lt;37 weeks (OR 0.53, 95% CrI 0.27\u20130.95) and neonatal death (OR 0.39, 95% CI 0.16\u20130.95). In women with a short cervix (\u226425 mm), vaginal progesterone reduced preterm birth &lt;34 weeks (OR 0.45, 95% CI 0.24\u20130.84).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Vaginal progesterone was the only intervention with consistent effectiveness for preventing preterm birth in singleton at\u2010risk pregnancies overall and in those with a previous preterm birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>In updated NMA, vaginal progesterone consistently reduced PTB in overall at\u2010risk pregnancies and in women with previous PTB.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15566","type":"journal-article","created":{"date-parts":[[2018,11,27]],"date-time":"2018-11-27T16:51:37Z","timestamp":1543337497000},"page":"556-567","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":126,"title":["Vaginal progesterone, oral progesterone, 17\u2010OHPC, cerclage, and pessary for preventing preterm birth in at\u2010risk singleton pregnancies: an updated systematic review and network meta\u2010analysis"],"prefix":"10.1111","volume":"126","author":[{"given":"A","family":"Jarde","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology McMaster University Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Lutsiv","sequence":"additional","affiliation":[{"name":"Provincial Council for Maternal and Child Health Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Beyene","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SD","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology McMaster University Hamilton ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,29]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"World Health Organization.Preterm Birth 2014. 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