The Risk for Preterm Labor in Women Receiving 17 Alpha-Hydroxyprogesterone Caproate Prophylaxis for Preterm Birth Prevention

Abstract

We sought to identify maternal or clinical characteristics of women likely to develop preterm labor (PTL) at <34 weeks' gestation while receiving 17 alpha-hydroxyprogesterone caproate (17P) prophylaxis. Current singleton gestations with prior preterm delivery enrolled for outpatient 17P administration at <27 weeks' gestation were identified ( N = 1177). Maternal and clinical characteristics were compared between women hospitalized and diagnosed with PTL at <34 weeks' gestation (PTL group, N = 270) and those without PTL (No PTL group, N = 660). PTL at <34 weeks' gestation occurred in 270/1177 (22.9%) of patients receiving 17P prophylaxis (mean gestational age at diagnosis was 28.3 +/- 4.0 weeks). Recurrent preterm delivery occurred in 73.3% of women with PTL at <34 weeks. Maternal age, marital status, race, tobacco use, cerclage, gestational age at start of 17P, and Medicaid status were similar between the groups. Women developing PTL at <34 weeks were more likely to have >1 prior preterm delivery than those without PTL (35.2% versus 25.9%, P = 0.006, odds ratio [95% confidence interval] 1.5 [1.1, 2.1]). Women receiving 17P prophylaxis remain at increased risk for PTL and preterm birth. Patient education and surveillance for PTL symptoms may be warranted in women with a history of more than one prior preterm delivery.

The Effects of Progesterone Therapy on the Gestation Length and Reduction of Neonatal Complications in Patients who had Received Tocolytic Therapy for Acute Phase of Preterm Labor

“…As mentioned above, the main routes are intra-muscular and suppository, whilst the oral route seems to be non-beneficial (23). However, an important study has revealed that women receiving 17-alpha-hydroxyl-progestrone-caproate prophylaxis before 27 weeks' gestation might have even an increased risk for preterm labor (34). Furthermore, it should be kept in mind that progesterone has no role in the prevention of preterm labor in twin pregnancy (35, 36) weekly injections of 17-alpha-hydroxyl-progestrone-caproate as well as vaginal progesterone suppositories can lead to a significant reduction in the rate of recurrent preterm labor among women who had treated with tocolytics to suppress the acute phase and also there is a considerable reduction in the neonatal complications.…”

Risk Factors Related to the Neonatal Mortality in Kurdistan Province, Iran: A Population-Based Case-Control Study

“…It was noted that although greater rate of neonatal mortality in males than females was reported in some studies (7,13), the current study results were consistent with those of the study conducted in Pakistan (10), the neighboring country of Iran. Although many different factors were implicated based on the geographic region of neonatal death including pneumonia, diarrhea, infection, asphyxia, trauma, sepsis, congenital abnormalities, metabolic disorders, pulmonary hemorrhage, necrotizing enter-colitis, and meningitis (10,13,(47)(48)(49)(50)(51)(52)(53), the main causes of neonatal mortality in Iran were respiratory distress syndrome, congenital anomalies, sepsis, infection, asphyxia, and pulmonary hemorrhage (47).…”

Pregnancy Outcomes of Women Receiving Compounded 17 α-Hydroxyprogesterone Caproate for Prophylactic Prevention of Preterm Birth 2004 to 2011

“…These investigations have provided valuable information regarding how 17P is being prescribed by health care providers, 9 rates of recurrent spontaneous preterm delivery, 10 results of late initiation or early termination of 17P treatment, [11][12][13] and influence of maternal characteristics and pregnancy history on treatment success. [14][15][16][17][18][19][20] The safety of 17P in regards to development of gestational diabetes 21 and its effect on preterm uterine contractions 22 have also been examined.…”