Vaginal Versus Intramuscular Progesterone for the Prevention of Recurrent Preterm Birth

Preterm birth is one of the leading causes of neonatal morbidity and mortality. One of the
greatest predictors of preterm birth is a history of prior spontaneous preterm birth.
Presently 17 hydroxyprogesterone caproate (intramuscular) is the only FDA approved product
for the prevention of recurrent preterm birth, however recent studies suggest that vaginal
progesterone may be used for this purpose, and may even be superior. The American College of
Obstetrics and Gynecology does not specify the optimal route of progesterone administration
for the prevention of recurrent preterm birth. It is our intention to compare vaginal and
intramuscular progesterone to see if one is superior.

Inclusion Criteria:

- Pregnant women with singleton pregnancies

- ≥18 years old

- Estimated gestational age less than 24 0/7 weeks

- Prior spontaneous preterm birth of a singleton pregnancy between 16 0/7-36 6/7 weeks.

- Patients are also required provide consent, demonstrate an understanding of the
purpose of the study, and agree to the study protocol.

Exclusion Criteria:

- History of an adverse reaction to progesterone;

- A contraindication to progesterone treatment;

- Placenta previa or accreta;

- Major fetal anomaly diagnosed on ultrasound or known chromosomal disorder;

- Multifetal gestation;

- Preterm labor, premature rupture of membranes, or clinical chorioamnionitis, at the
time of enrollment