European Journal of Cardiovascular Medicine

Background: Preterm birth (PTB) remains a significant challenge in perinatal healthcare, contributing to a substantial portion of neonatal mortality and long-term disabilities. Various risk factors contribute to PTB, necessitating effective preventive measures. Progesterone supplementation has emerged as a promising intervention to reduce the risk of PTB, but the route of administration and its efficacy remain under investigation. Methods: This prospective, randomized comparative study enrolled 600 pregnant patients divided into two groups receiving either oral micronized progesterone (OMP) or vaginal micronized progesterone (VMP). Patients were followed up fortnightly for signs of preterm labor (PTL) and perinatal outcomes. Statistical analyses were performed using unpaired t-tests, Fisher tests, and chi-square tests. Results: The study found significant differences in perinatal outcomes between the OMP and VMP groups. While both groups had similar rates of neonatal sepsis and hypoxemic ischemic encephalopathy, the VMP group demonstrated a higher proportion of asymptomatic births and a lower incidence of birth asphyxia compared to the OMP group. Additionally, the mean APGAR score at 1 minute was significantly lower in the OMP group, while birth weight distribution differed significantly between the two groups. Neonates in the VMP group had higher birth weights and lower rates of NICU admission, with a shorter NICU stay compared to the OMP group. Conclusion: Vaginal micronized progesterone appears to be more effective than oral micronized progesterone in preventing PTL and improving perinatal outcomes, including reducing neonatal morbidity and NICU admissions. These findings underscore the importance of route-specific progesterone administration in mitigating the risks associated with PTB. Further research is warranted to elucidate the mechanisms underlying the differential efficacy of progesterone administration routes and optimize preventive strategies for PTB.