Implementation Feasibility and Pregnancy Outcomes of a Regional Vaginal Progesterone Protocol for Preterm Birth Prevention in Health Region 1, Northern Thailand: A Three-Year Multicentre Descriptive Study
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Abstract
Objective: To evaluate feasibility, programme uptake, implementation indicators, and pregnancy outcomes during three years of a regional vaginal progesterone protocol in Northern Thailand.
Materials and Methods: This prospective multicentre descriptive implementation study included high-risk women receiving vaginal progesterone during October 2016–September 2019. Eligible singleton pregnancies had either a previous spontaneous preterm birth at 20(+0)–36(+6) weeks or cervical length below 25 mm at 20–24 weeks. Micronised vaginal progesterone 200 mg nightly was provided without charge. Prospectively collected programme indicators were mapped retrospectively to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Results: Among 1,114 participants, 1,075 (96.5%) had previous preterm birth and 39 (3.5%) had a short cervix. Of the previous-preterm-birth group, 869 (80.8%) delivered at term and 206 (19.2%) had recurrent preterm birth. Preterm birth occurred at 34–36, 28–33, and <28 weeks in 13.6%, 4.4%, and 1.6% of participants. The short-cervix group was analysed descriptively. The protocol was implemented in 103/103 hospitals (100%); complete antenatal follow-up was reported for 89.2%, protocol documentation completeness was 91.8%, and provider-rated feasibility was 91.3%. Cervical length assessment was available at 11/103 hospitals (10.7%). Daily medication adherence, screening coverage, referral completion, causes of preterm birth, and neonatal outcomes were not systematically recorded. No comparative effectiveness analysis was possible without a concurrent control group.
Conclusion: Implementation across 103 public hospitals was feasible. However, individual-level screening coverage, referral completion, and daily medication adherence could not be fully assessed. The observed recurrence rate is descriptive and cannot establish progesterone effectiveness. This programme may inform implementation in similar settings.
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