723: Use of progesterone to prevent preterm births: Attitudes and practices of U.S. Obstetrician-Gynecologists

Abstract

PRACTICES OF U.S. OBSTETRICIAN-GYNECOLOGISTS ZSAKEBA HENDERSON, MICHAEL POWER, EVE LACKRITZ, VINCENZO BERGHELLA, JAY SCHULKIN, Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, American College of Obstetricians and Gynecologists, Research Department, Washington, District of Columbia, Thomas Jefferson University, Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Philadelphia, Pennsylvania OBJECTIVE: To determine current attitudes and practices regarding the use of progesterone to prevent preterm birth among members of the American College of Obstetricians and Gynecologists (ACOG). STUDY DESIGN: A self-administered mail survey was sent to members of the ACOG Collaborative Ambulatory Research Network in March-May 2007. Clinicians were eligible to complete the survey if they currently practiced obstetrics in the U.S. The survey consisted of 36 questions, including respondents= demographic characteristics, their preterm birth risk factor knowledge and screening practices, and their understanding and use of progesterone for the prevention of preterm birth. RESULTS: The overall response rate, adjusted for eligibility, was 52% (N 345). The primary specialty of 89% of respondents was general Ob/Gyn, followed by maternal-fetal medicine (8%). Seventy-four percent reported that they currently recommend or offer progesterone for prevention of preterm birth; of those (n 254), 42% reported recommending it to women with any prior preterm birth 37 weeks, and 55% reported recommending progesterone to women without a prior preterm birth for other conditions in the current pregnancy (39% for prematurely dilated or effaced cervix, 35% for short cervix on ultrasound, and 27% for cerclage). Of all respondents, 55% considered prophylactic use of progesterone for high risk patients an effective treatment to reduce the incidence of preterm birth. However, some were very concerned that it was not easily available (36%), not covered by insurance (31%), that more data are needed (28%), and that there may be long-term fetal or neonatal effects (27%). CONCLUSION: Nearly three-fourths of responding physicians reported recommending or offering progesterone for the prevention of preterm birth, and over half of them reported offering it to women without a prior preterm birth. Despite this widespread use of progesterone, concerns still remain regarding long-term effects and the need for more data to support its use.