Prevention of Recurrent Preterm Delivery by 17 Alpha-Hydroxyprogesterone Caproate (original) (raw)
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Estimated Effect of 17 Alpha-Hydroxyprogesterone Caproate on Preterm Birth in the United States
Obstetrics & Gynecology, 2005
OBJECTIVE: A multicenter, randomized placebo-controlled trial among women with singleton pregnancies and a history of spontaneous preterm birth found that weekly injections of 17 alpha-hydroxyprogesterone caproate (17P), initiated between 16 and 20 weeks of gestation, reduced preterm birth by 33%. The current study estimated both preterm birth recurrence and the potential reduction in the national preterm birth rate.
Journal of Maternal-Fetal and Neonatal Medicine, 2010
Evaluation of an outpatient 17 α-hydroxyprogesterone caproate (17P) administration programme. A retrospective analysis of data collected from patients with a history of preterm birth (PTB) and current singleton gestation enrolled between 16.0 and 20.9 weeks' gestational age (GA) for weekly outpatient 17P administration and nursing assessment between 7/2004 and 12/2007 was conducted (n=3139). The population was mostly white (50.3%), 18-35 years old (77.7%), and married (67.0%). Median GA at 17P initiation and stop was 17.4 (16.0, 20.9) weeks and 35.1 (18.6, 37.4) weeks. Mean injections per patient were 16.5±4.9, at an interval of 7.2 days. Median GA at delivery was 37.3 (18.6, 44.0) weeks. Rate of recurrent spontaneous PTB was 29.8%, with 15.5% and 7.0% with PTB at <35 and <32 weeks. This represents the largest cohort reported to date of patients prescribed 17P therapy in clinical practice to prevent recurrent spontaneous PTB.
Role of 17 α Hydroxy Progesterone Caproate (17OHPC) in the Prevention of Preterm Labor
The Journal of Obstetrics and Gynecology of India, 2012
Objective To evaluate the role of 17 a hydroxyprogesterone caproate (17OHPC) in the prevention of preterm labor in high risk asymptomatic patients with a history of preterm delivery. Methods The study included 96 patients with a singleton pregnancy and having a prior preterm birth. They were divided in 2 groups, group I (treatment group) included 46 asymptomatic patients who were given 17OHPC injections starting from 16-20 weeks till 36 weeks and group II (control group) included 50 patients who did not receive any treatment. Results The incidence of preterm delivery was found to be 6.9 %. The median gestational age at delivery was 36 weeks in group I and 33 W5D in controls. 50 % cases in group I and 80 % of controls delivered prematurely in the group with a prior preterm birth between 20-28 weeks. Conclusion In patients who had a prior history of a preterm delivery the recurrence of a preterm birth was less in the treated group as compared to controls. The median gestational age at delivery was significantly higher in 17OHPC treated patients with history of earliest prior preterm delivery at 20-28 weeks.
American journal of obstetrics and gynecology, 2015
Prematurity is the leading cause of neonatal morbidity and mortality amongst non-anomalous neonates in the United States. Intramuscular 17-alpha hydroxyprogesterone caproate (17OHP-C) injections reduce the risk of recurrent prematurity by approximately one third. Unfortunately, prophylactic 17OHP-C is not always effective, and one-third of high-risk women will have a recurrent PTB despite 17OHP-C therapy. The reasons for this variability in response are unknown. Previous investigators have examined the influence of a variety of factors on 17OHP-C response, but have analyzed data used a fixed outcome of 'term' delivery to define progesterone response. We hypothesized that the demographics, history, and pregnancy course among women who deliver at a similar gestational age with 17-alpha hydroxyprogesterone caproate (17OHP-C) for recurrent spontaneous preterm birth (SPTB) prevention differs when compared to those women who deliver later with 17OHP-C, and that these associations ...
American Journal of Obstetrics and Gynecology, 2010
OBJECTIVE: We sought to examine if 17-alpha-hydroxyprogesterone caproate (17OHPC) effectiveness is dependent on the earliest gestational age (GA) at prior spontaneous preterm birth (SPTB) when administered in the clinical setting. STUDY DESIGN: Women enrolled for outpatient services with current singleton gestation and Ն1 prior SPTB between 20-36.9 weeks were identified. Data were divided into 3 groups according to earliest GA of prior SPTB (20-27.9, 28-33.9, and 34-36.9 weeks). We compared GA at delivery of current pregnancy and incidence of recurrent SPTB between women enrolled in outpatient 17OHPC administration program (n ϭ 2978) and women receiving other outpatient services without 17OHPC (n ϭ 1260). RESULTS: Rates of recurrent SPTB for those with and without 17OHPC prophylaxis, respectively, according to GA at earliest SPTB were: 20-27.9 weeks at earliest SPTB, 32.2% vs 40.7%, P ϭ .025; 28-33.9 weeks at earliest SPTB, 34.1% vs 45.5%, P Ͻ .001; and 34-36.9 weeks at earliest SPTB, 29.3% vs 38.8%, P Ͻ .001. CONCLUSION: 17OHPC given to prevent recurrent SPTB is effective regardless of GA at earliest SPTB.
Prevention of Preterm Birth in Triplets Using 17 Alpha-Hydroxyprogesterone Caproate
Obstetrics & Gynecology, 2009
Objective-To assess whether 17 alpha-hydroxyprogesterone caproate reduces the rate of preterm birth in women carrying triplets. Methods-We performed this randomized, double blinded, placebo controlled trial in 14 centers. Healthy women with triplets were randomized to weekly intramuscular injections of either 250 mg of 17 alpha-hydroxyprogesterone caproate or matching placebo, starting at 16-20 weeks and ending at delivery or 35 weeks of gestation. The primary study outcome was delivery or fetal loss prior to 35 weeks. Results-One hundred thirty-four women were randomized, 71 to 17 alpha-hydroxyprogesterone caproate and 63 to placebo; none were lost to followup. Baseline demographic data were similar in the two groups. The proportion of women experiencing the primary outcome (a composite of delivery or fetal loss prior to 35 0/7 weeks) was similar in the two treatment groups : 83% of pregnancies in the 17 alpha-hydroxyprogesterone caproate group and 84% in the placebo group, relative risk (RR) 1.0, 95% confidence interval (CI) 0.9 to1.1. The lack of benefit of 17 alpha-hydroxyprogesterone caproate was evident regardless of the conception method or whether a gestational age cut off for delivery was set at 32 or 28 weeks. Conclusion-Treatment with 17 alpha-hydroxyprogesterone caproate did not reduce the rate of preterm birth in women with triplet gestation.
Data Revues 00029378 V199i6ssa S0002937808014646, 2011
The incidence of intrauterine fetal death (IUFD) is greater in monochorionic diamniotic (MCDA) compared with dichorionic diamniotic (DCDA) twin pregnancy and may be unpredictable, prompting various recommendations for routine delivery at Ն34 weeks gestation. We examined the incidence of IUFD in twin pregnancy according to chorionicity and fetal growth to further determine optimal timing of delivery. STUDY DESIGN: Ten year retrospective cohort analysis of all consecutive twin deliveries at a single tertiary care centre (1997-2006). Chorionicity was determined by placental examination. Intrauterine growth restriction (IUGR) was defined as birth weight below the 5th percentile for gestational age and significant inter-twin weight discordance as Ն20%. RESULTS: Of 276 MCDA (25.3%) and 818 DCDA twin pregnancies (74.7%) Ն24 weeks delivered, the incidence of IUFD in MCDA twins was three times that in DCDA twins [11/276 (3.9) % vs. 11/818 (1.3 %) pϽ0.001]. The majority of deaths in MCDA twins (8/11; 72.7%) were associated with twin twin transfusion (TTTS), all of which occurred before 34 weeks gestation. After 34 weeks, the prospective risk of IUFD was similar in MCDA and DCDA pregnancies [2/205 (0.97% vs. 6/708 (0.84%) pϭ1] with 2/2 IUFDS in MCDA and 4 /6 IUFDS in DCDA pregnancies associated with growth discordance or IUGR. In apparently normally grown twins, the incidence of IUFD was similar in MCDA and DCDA twins [1% vs 0.87%) pϭ1.0] with a prospective risk of IUFD of Ͻ 0.5% in both at Ն34 weeks. The risk of IUFD was greater in pregnancies complicated by growth discordance or IUGR (TTTS excluded) [MCDA 2/82 (2.4%) vs DCDA 5/243 (2.1%); pϭ1] with a prospective risk of IUFD at Ն34 weeks of 3.4 in MCDA and 1.8 in DCDA pregnancies rising to 4.3 and 2.0 at Ն36 weeks gestation. CONCLUSION: Preterm delivery should be considered in all twin pregnancy complicated by growth discordance or IUGR. The benefit of routine preterm delivery, even in MCDA, in normally grown twins is less clear.
Single dose 17 alpha-hydroxyprogesterone caproate in preterm labor: a randomized trial
Archives of Gynecology and Obstetrics, 2012
Objective To evaluate the effect of a single 250-mg dose of 17 alpha-hydroxyprogesterone caproate (17-OHPC) intramuscularly as adjunct to nifedipine tocolysis in preterm labor. Method Women diagnosed with threatened preterm labor between 22 and 35 weeks’ gestation scheduled to receive nifedipine tocolysis and prophylactic antenatal corticosteroid were randomized to a single intramuscular injection of 250 mg of 17-OHPC or placebo saline in a double-blind fashion. Nifedipine tocolysis and corticosteroids were administered to all participants. Further management was otherwise carried out according to providers’ discretion. Main outcome measures are delivery within 48 h and 7 days. Results Data were analyzed for the 56 participants randomized to 17-OHPC and 56 randomized to placebo. Delivery rates within 48 h were 11/54 (20.4%) versus 15/56 (26.8%) RR 0.76 (95% CI 0.38–1.51) and within 7 days were 13/52 (25.0%) versus 19/54 (35.2%) RR 0.71 (95% CI 0.39–1.29) for 17-OHPC and placebo groups, respectively, and were similar. Recruitment to delivery interval, gestation at delivery, delivery rate before 34 weeks’ and 37 weeks’ gestation, and neonatal outcomes were also similar. Conclusion The results indicated that adjunctive single-dose 17-OHPC in combination with nifedipine tocolysis for threatened preterm labor did not delay delivery.