Hormone ‘halves risk of premature birth,’ says the Mail. But its report is wildly inaccurate

    18 May 2015

    As a gynaecologist, I was appalled to read this story about a supposedly ‘groundbreaking’ treatment to stop premature births in the Mail (I read it on the online Mail site but in fact the culprit is The Mail on Sunday). Let me quote from it before telling you what it gets utterly wrong. Note my emphases in bold:

    A hormone treatment that can help prevent premature births could be made more widely available to thousands of at-risk mothers-to-be.

    The groundbreaking treatment, not yet widely available on the NHS, sees women given a daily dose of progesterone. This is dubbed the ‘pregnancy hormone’ by doctors, and levels naturally rise during pregnancy to help prevent the cervix from opening too early.

    Doctors say that treating at-risk women with extra progesterone could cut the risk of early labour by at least half.

    And this month, the Government health watchdog the National Institute for Health and Care Excellence (Nice) is expected to recommend the treatment for women with specific risk factors, including a history of a previous early labour and a shortened cervix. As many as 54,000 women in England go into premature labour – before 36 weeks – every year …

    Early labour can be caused by a shortened cervix, which makes it harder for the body to support the pregnancy and increases the risk of infection.

    Studies show that a daily progesterone treatment, which is given as a pessary, could reduce the number of pre-term births in at-risk women by at least 50 per cent …

    Women at risk of early labour are usually treated with a cervical stitch, a procedure that involves ‘stitching’ tape around the cervix to keep it closed and prevent a baby from being born prematurely.
    The stitch is normally a straightforward procedure, but it does carry a risk of infection, and undergoing the procedure can itself lead to pre-term delivery.

    The terms ‘early labour’ and ‘premature labour’ have been conflated as though they refer to the same thing, and two distinct though related concepts have been merged into one: cervical incompetence and preterm labour.

    Early labour is what a woman experiences prior to the onset of labour. The term is usually used to apply to those entering labour after 37 weeks.

    Premature labour (i.e., premature labour) is labour occurring prior to 37 weeks. It has many potential causes, among which is infection. It increases the risk of a baby dying or suffering long-term health issues.

    And the ‘groundbreaking’ treatment?

    Progesterone supplementation has been shown in 36 randomised control trials performed over the last 20 years to decrease the risk of preterm labour; in selected women by up to 50 per cent. Indeed, progesterone has been used to prevent preterm labour in some way for 20-odd years and it’s insulting to the intelligence of women everywhere to present this as a new finding, particularly those who will have experienced preterm labour.

    Cervical incompetence or ‘weakness’ is a specific risk factor for preterm labour that describes a cervix that rapidly and painlessly dilates, usually causing a second trimester miscarriage but implicated as a cause of early preterm labour. It is not well understood why this happens, as not all patients with incompetence will experience preterm labour. Traditionally it has been treated with the placement of a cervical cerclage (stitch) that multiple randomised trials have shown to be effective and/or progesterone supplementation. Contrary to what the article states, it does not increase ‘the risk of infection’.

    Preterm labour is the leading cause of foetal mortality, costs the healthcare system hundreds of millions of pounds, causing immeasurable suffering and grief and is one of the most feared complications of pregnancy. Women are entitled to accurate reporting on this subject. They have not received it here.

    Dr Tarek Arab is Assistant Professor of Obstetrics & Gynaecology
    at Jeddah University School of Medicine