Abstract
INTRODUCTION: Barriers in obtaining vaginal progesterone (VP) may adversely affect perinatal outcomes in women with short cervix. Aim of this study is to evaluate if delay in obtaining VP was associated with increased rate of sPTB. METHODS: Retrospective cohort study of singleton pregnancy with incidental short cervix (ISC) ≤20mm, prescribed VP and delivered at University of Illinois at Chicago, between June 2016 and June 2018. Rates of sPTB <37 weeks in women with delay in treatment were compared to women without delay. IRB approval was obtained. RESULTS: A total of 74 women with ISC were prescribed VP: 69(93%) received insurance approval. Of those 69, 8 (12%) received initial claim rejection, but subsequently received approval only for oral Prometrium to use vaginally. 15/74 (22%) women did not receive VP due to barriers or other causes. 29/47 (62%) who received VP timely, delivered preterm. 12 (20%) women encountered an insurance delay in obtaining VP ≥14 days, and 4 of those experienced sPTB. There was no significant difference in sPTD rate in women who began VP <14 days versus those ≥14 days, p=0.07. Those who experienced a delay compared to those with no VP at all, still had lower rate of sPTB 4/12 (33%) versus 11/15 (73%), respectively (p=0.038). CONCLUSION: Despite barriers, 93% of patients had access to VP treatment. Delay ≥14 days did not impact the rate of PTBs <37 weeks. Patients who received VP, despite delay, had a lower rate of PTBs than those who did not receive it at all.
Published Version
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