Prophylaxis with 17 alpha-hydroxyprogesterone for prevention of recurrent preterm delivery: Does the number of previous preterm deliveries matter?

Abstract

OF RECURRENT PRETERM DELIVERY: DOES THE NUMBER OF PREVIOUS PRETERM DELIVERIES MATTER? HELEN HOW, JOHN BARTON, NIKI ISTWAN, DEBBIE RHEA, GARY STANZIANO, University Of Cincinnati, Ob/Gyn, Cincinnati, Ohio, University Of Kentucky, Obstetrics & Gynecology, Lexington, Kentucky, Matria Healthcare, Marietta, Georgia OBJECTIVE: To determine the effectiveness of 17 hydroxyprogesterone progesterone (17OHP) prophylaxis according to number of previous preterm deliveries (PTD) and gestational age at initiation of treatment. STUDY DESIGN: Analysis of a database of women enrolled for outpatient 17OHP prophylaxis for prevention of spontaneous PTD (SPTD). Study patients were singleton gestations having at least one prior PTD, starting 17OHP at !27 weeks and who were without symptoms of preterm labor. Excluded were women with cerclage and those withdrawing from the program following the initial test injection. Data were divided into three groups according to the number of PTD (1, 2, O2) and stratified to initiation of 17OHP at 16-20.9 weeks and 21-26.9 weeks. Outcome variables were PTD at !37, !35 and !32 weeks’ gestation. Various !2 and non-parametric methods were used to compare the three groups overall and within strata; p!0.05 was considered statistically significant. RESULTS: Overall, 906 women met inclusion criteria and received a mean of 14.3 G 4.8 17OHP injections beginning at 19.8 G 3.0 weeks. Patients with two previous PTD have higher rates of being a smoker and unmarried (p!0.001). There were no significant differences in SPTD rates according to the time of initiation of 17 OHP. However, the rates of SPTD were significantly higher in those with 2 PTD as compared to those with one PTD (Table). S58 SMFM Abstracts