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Am J Perinatol 2020; 37(07): 659-665
DOI: 10.1055/s-0039-3400448
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Intramuscular 17α-Hydroxyprogesterone in Women Screened for Shortened Cervical Length

S. Lindsay Wood
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Bria N. Williams
2   The University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
,
Jeff M. Szychowski
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
John Owen
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations Funding None.
Further Information

Publication History

17 May 2019

14 October 2019

Publication Date:
22 November 2019 (online)

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Abstract

Objective This article assesses the effect of weekly intramuscular 17α-hydroxyprogesterone caproate (17P) on midtrimester cervical length (CL) in patients with prior spontaneous preterm birth.

Study Design Retrospective cohort study of all singletons that underwent CL screening at a single institution from 2011 to 2016. The timing of 17P exposure was assessed. The primary outcome was shortest midtrimester CL. Secondary outcomes included gestational age at delivery, rate of short cervix, cerclage, preterm labor admission, and preterm premature rupture of the membranes (PROM). Multivariable regression analysis was used to model the relationship between 17P exposure and shortest CL, controlling for selected covariates.

Results Of 409 women who underwent screening, 211 received and 198 did not receive 17P prior to the last CL. Rates of short cervix and cerclage were similar between groups. After adjusting for covariates, the shortest CL was significantly shorter in the 17P group. In a secondary analysis, those who received any 17P (n = 293) versus those who did not (n = 116) had higher rates of preterm PROM, preterm labor admission, and cerclage. After controlling for covariates, gestational age at delivery was significantly lower in those receiving 17P.

Conclusion In high-risk patients undergoing CL screening for ultrasound-indicated cerclage, 17P did not prevent midtrimester cervical shortening or prolong gestation.

Keywords

cervical length screening - preterm birth - effect of progesterone - recurrent preterm birth prevention - cerclage

Note

This study was presented in part at the 2017 American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting, San Diego, CA, May 6–9, 2017.


 

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