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Recording available 2/16-5/2
Recording available 2/16-5/2
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Abstract Award
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Foundation Awardee

Poster Session 3

Category: Epidemiology

Poster Session 3

(913) Consensus on Vaginal Progesterone Use for Preterm Birth Prevention: The SUSTAIN-V2 Consensus

Thursday, February 12, 2026
10:30 AM - 12:00 PM  
Objective:
The SUSTAIN-V2 (Safety, Utilization, and Therapeutic Benefits of Vaginal Progesterone) consensus aimed to assess expert agreement on the clinical use, efficacy, and safety of vaginal micronized progesterone for preterm labor prevention in high-risk obstetric populations. The focus included optimal screening tools, patient selection, and timing of therapy initiation to maximize benefits in singleton and twin pregnancies

Study Design:

A perception-mapping consensus was conducted among experienced obstetricians with over 1500 man-years of cumulative clinical experience. Participants rated 17 evidence-based statements on a 5-point Likert scale. A weighted score >100 indicated strong consensus. Data were analyzed using GraphPad 10.4.0.

Results:

Of 17 statements, 13 reached weighted scores >100, reflecting strong agreement.


  • High consensus supported using cervical length assessment with vaginal progesterone to manage high-risk pregnancies (114.2).

  • Routine daily use of 200 mg vaginal progesterone was endorsed for women with short cervix and prior preterm birth, including ART-conceived pregnancies (119.7, 120.2).

  • Early initiation before 20 weeks and combining cervical imaging with uterocervical angle assessment were also supported (114.8).

  • Progesterone use in arrested labor and mild cervical shortening achieved strong agreement (116.3, 102.5).

  • Use of 400 mg vaginal progesterone in ART pregnancies from mid-trimester was also well supported (120.2).

  • The treatment was considered well-tolerated and guideline-aligned across singleton and twin gestations (103.9).


Statements involving biomarkers, PCOS-related luteal support, and PAPP-A-based personalization received lower scores (e.g., 39.7, 54.2), indicating areas requiring further research.

The overall mean response scores were: Agree: 60±19 (95% CI 50 to 70), Strongly agree: 32±22 (95% CI 20 to 43), p< 0.0001

Conclusion:
The panel confirmed the safety and utility of vaginal micronized progesterone, in preterm birth prevention. Strong consensus was reached on early initiation and integration with cervical screening in both spontaneous and ART pregnancies