17-alpha-hydroxyprogesterone caproate for the prevention of preterm birth in women with prior preterm birth and a short cervical length

Vincenzo Berghella, Dana Figueroa, Jeff M. Szychowski, John Owen, Gary D.V. Hankins, Jay D. Iams, Jeanne S. Sheffield, Annette Perez-Delboy, Deborah A. Wing, Edwin R. Guzman

Research output: Contribution to journalArticle

97 Scopus citations

Abstract

Objective: We sought to evaluate 17-alpha-hydroxyprogesterone caproate (17P) for prevention of preterm birth (PTB) in women with prior spontaneous PTB (SPTB) and cervical length (CL) <25 mm. Study Design: We conducted planned secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development-sponsored randomized trial evaluating cerclage for women with singleton gestations, prior SPTB (17-33 6/7 weeks), and CL <25 mm between 16-22 6/7 weeks. Women were stratified at randomization to intent to use or not use 17P. The effect of 17P was analyzed separately for cerclage and no-cerclage groups. Primary outcome was PTB <35 weeks. Results: In 300 women, 17P had no effect on PTB <35 weeks in either cerclage (P = .64) or no-cerclage (P = .51) groups. Only PTB <24 weeks (odds ratio, 0.08) and perinatal death (odds ratio, 0.14) were significantly lower for those with 17P in the no-cerclage group. Conclusion: 17P had no additional benefit for prevention of PTB in women who had prior SPTB and got ultrasound-indicated cerclage for CL <25 mm. In women who did not get cerclage, 17P reduced previable birth and perinatal mortality.

Original languageEnglish (US)
Pages (from-to)351.e1-351.e6
JournalAmerican journal of obstetrics and gynecology
Volume202
Issue number4
DOIs
StatePublished - Apr 2010

Keywords

  • cerclage
  • preterm birth
  • progesterone
  • short cervical length

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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    Berghella, V., Figueroa, D., Szychowski, J. M., Owen, J., Hankins, G. D. V., Iams, J. D., Sheffield, J. S., Perez-Delboy, A., Wing, D. A., & Guzman, E. R. (2010). 17-alpha-hydroxyprogesterone caproate for the prevention of preterm birth in women with prior preterm birth and a short cervical length. American journal of obstetrics and gynecology, 202(4), 351.e1-351.e6. https://doi.org/10.1016/j.ajog.2010.02.019