17<scp>OHP</scp>‐C in patients with spontaneous preterm labor and intact membranes: is there an effect according to the presence of intra‐amniotic inflammation?

Yoneda, Satoshi; Yoneda, Noriko; Shiozaki, Arihiro; Yokosuka, Osamu; Ueno, Takahiro; Niimi, Hideki; Kitajima, Isao; Tamura, Kentaro; Kawasaki, Yukako; Makimoto, Masami; Yoshida, Taketoshi; Saito, Shigeru

doi:10.1111/aji.12867

Cited by 8 publications

(11 citation statements)

References 78 publications

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“…A retrospective study examined the efficacy of 17‐OHPC administration in treating IAI in patients with threatened premature delivery before 32 weeks' gestation 3 . In this study, 17‐OHPC administration in patients with mild IAI and without any bacterial infection prolonged pregnancy duration.…”

Section: Discussionmentioning

confidence: 99%

“…The administration of 17‐alpha‐hydroxyprogesterone caproate (17‐OHPC) prolongs pregnancy in mild IAI cases without bacterial infections. However, 17‐OHPC administration showed no effect on gestation period in severe IAI cases 3 . Conversely, continuous transabdominal amnioinfusion (TA), combined with antibiotics, controlled IAI via a flush‐out effect and prolonged pregnancies with preterm premature rupture of membranes (PPROM) 4–6 .…”

Section: Introductionmentioning

confidence: 99%

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Successful treatment of severe intra‐amniotic inflammation and cervical insufficiency with continuous transabdominal amnioinfusion and cerclage: A case report

Ikeda

Ono

Tsumura

et al. 2020

J of Obstet and Gynaecol

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Severe intra-amniotic inflammation, even with a negative bacterial culture, can lead to premature labor. We report a 43-year-old multiparous woman with severe intra-amniotic inflammation and cervical insufficiency at 23 weeks and 5 days of gestation. Continuous transabdominal amnioinfusion was started 2 days after the diagnosis. The amniotic fluid interleukin-6 level normalized after 2 days of treatment. She underwent Shirodkar cervical cerclage on day 7. Despite termination of amnioinfusion and catheter removal on day 16, the pregnancy was maintained without any subsequent treatment. At 33 weeks and 5 days of gestation, an intrauterine Ureaplasma parvum infection and the onset of contractions led to repeat cesarean delivery. The birth weight was 2292 g, and the Apgar scores were 8/8. Both mother and infant had good outcomes. Continuous transabdominal amnioinfusion may have eliminated factors causing intra-amniotic inflammation, thereby prolonging the pregnancy and improving the infant's prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Successful treatment of severe intra‐amniotic inflammation and cervical insufficiency with continuous transabdominal amnioinfusion and cerclage: A case report

Ikeda

Ono

Tsumura

et al. 2020

J of Obstet and Gynaecol

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“…Thus, it is not known whether 17OHP‐C is effective for preventing preterm labor (PTL). However, 17OHP‐C, which might be effective in limited PTL cases with mild sterile intra‐amniotic inflammation, was administered prophylactically from 16 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Metronidazole (vaginal tablet) was administered for bacterial vaginosis (BV) to prevent ascending inflammation and/or infection of the intra‐amnion . Additionally, 17‐alpha‐hydroxyprogesterone caproate (17OHP‐C) was administered from 16 weeks. She was hospitalized for physical rest from 15 +1 weeks.…”

Section: Case Reportmentioning

confidence: 99%

Multiple management strategies to prolong gestational period after radical trachelectomy

Ito

Yoneda

Shiozaki

et al. 2019

Clinical Case Reports

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“…PTL patients administered 17OHP‐C during the pregnancy period were also excluded. Since 2016, 17OHP‐C while giving tocolytic agent(s) is frequently used to treat PTL in our hospital 14 . Natural progesterone that is not covered by medical insurance is not used for PTL.…”

Section: Methodsmentioning

confidence: 99%

Method to evaluate intravenous maintenance tocolysis for preterm labor

Yoneda

2020

J of Obstet and Gynaecol

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Aim: Despite the lack of evidence-based medicine, continuous intravenous maintenance tocolysis is the main treatment for preterm labor (PTL) in Japan because it is considered to prolong the gestational period. This treatment needs to be evaluated in more detail, and we herein propose one method to assess maintenance tocolysis using the timing of delivery by PTL patients. Methods: PTL patients (n = 307) were divided into three groups according to delivery weeks of gestation. Group A (severe PTL) delivered at <34 weeks, group B (mild PTL) at 34-37 weeks and group C (cases suspected overtreatment) at ≥38 weeks. The percentages of patients in each group was calculated and clinical characteristics were compared between groups. Results: The percentages of patients (%) in groups A, B and C were 33.9, 43.6 and 22.5, respectively. Gestational weeks on admission, maternal white blood cell count and C-reactive protein, PTL index, fetal fibronectin levels in vaginal secretions, amniotic fluid interleukin-8 levels, staying at neonatal intensive care unit were significantly different between these three groups by analysis of variance. Furthermore, amniotic fluid interleukin-8 levels were significantly higher in group B (3.5 [0.1-46.5] ng/mL) than in group C (1.7 [0.1-16.1], P < 0.05). Conclusions: PTL patients were classified according to the prognosis. The ratio of patients in each group represented the severity of PTL and the risk of overtreatment. When this ratio is investigated on a nationwide scale, the use of intravenous maintenance tocolysis or definition of PTL may need to be reconsidered.

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17OHP‐C in patients with spontaneous preterm labor and intact membranes: is there an effect according to the presence of intra‐amniotic inflammation?

Abstract: 17OHP-C could prolong gestational period in limited PTL cases with sterile mild intra-amniotic inflammation.

Cited by 8 publications

References 78 publications

Successful treatment of severe intra‐amniotic inflammation and cervical insufficiency with continuous transabdominal amnioinfusion and cerclage: A case report

Successful treatment of severe intra‐amniotic inflammation and cervical insufficiency with continuous transabdominal amnioinfusion and cerclage: A case report

Multiple management strategies to prolong gestational period after radical trachelectomy

Method to evaluate intravenous maintenance tocolysis for preterm labor

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