Use of 17-Hydroxyprogesterone Caproate in Twin Gestations With a Prior Singleton Spontaneous Preterm Birth [30T

Abstract

INTRODUCTION: The purpose was to determine if weekly 17-hydroxyprogesterone caproate injections prevent preterm birth in women with a twin pregnancy and a history of a singleton spontaneous preterm birth. METHODS: Retrospective cohort study of women with twin gestation and prior singleton spontaneous PTB at two institutions between 2005 and 2016. Study group included women receiving 17P while the control group did not. Primary outcome was twin spontaneous PTB <34 weeks. Secondary outcome was composite neonatal morbidity: respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), neonatal intensive care nursery admission, and fetal or infant death prior to discharge. IRB approval was obtained. RESULTS: 79 patients were included. 27 women received weekly 17P and 52 did not. There were no significant differences in maternal demographics (Table 1) or preterm birth (Table 2) aside from maternal age. Spontaneous PTB <34 weeks occurred in 16 study patients (59%) versus 24 (46%) controls (OR 1.69, 95% CI 0.68-4.54). There was no difference in the rate of spontaneous PTB <32 weeks (33% vs 31% [OR 1.12; 95% CI 0.42-3.06]), <28 weeks (18% vs 19% [OR 0.95, 95% CI 0.32-3.18]), and <24 weeks (11% vs 13% [OR 0.8, 95% CI 0.21-3.42]) between the study group and control group, respectively. Composite neonatal morbidity occurred in 20 pregnancies (74%) in the study group and 41 pregnancies (79%) in the control group (OR 0.76, 95% CI 0.27-2.12). CONCLUSION: Weekly 17P injections do not appear to prevent spontaneous preterm birth or neonatal complications in twin gestations with prior singleton spontaneous preterm birth.