Rate Of Recurrent Preterm Birth Research Articles

Recurrent preterm birth: data from the study "Birth in Brazil".

ABSTRACTOBJECTIVE Describe and estimate the rate of recurrent preterm birth in Brazil according to the type of delivery, weighted by associated factors.METHODS We obtained data from the national hospital-based study “Birth in Brazil”, conducted in 2011 and 2012, from interviews with 23,894 women. Initially, we used the chi-square test to verify the differences between newborns according to previous prematurity and type of recurrent prematurity. Sequentially, we applied the propensity score method to balance the groups according to the following covariates: maternal age, socio-economic status, smoking during pregnancy, parity, previous cesarean section, previous stillbirth or neonatal death, chronic hypertension and chronic diabetes. Finally, we performed multiple logistic regression to estimate the recorrence.RESULTS We analyzed 6,701 newborns. The rate of recurrence was 42.0%, considering all women with previous prematurity. Among the recurrent premature births, 62.2% were spontaneous and 37.8% were provider-initiated. After weighting by propensity score, we found that women with prematurity have 3.89 times the chance of having spontaneous recurrent preterm birth (ORaj = 3.89; 95%CI 3.01–5.03) and 3.47 times the chance of having provider-initiated recurrent preterm birth (ORaj = 3.47; 95%CI 2.59–4.66), compared to women who had full-term newborns.CONCLUSIONS Previous prematurity showed to be a strong predictor for its recurrence. Thus, expanding and improving the monitoring and management of pregnant women who had occurrence of prematurity strongly influence the reduction of rates and, consequently, the reduction of infant morbidity and mortality risks in the country.

Recurrent preterm birth rates before and after the PROLONG Trial

The PROLONG trial, which found that 17-hydroxyprogesterone caproate (17-OHP) did not lead to a reduction in recurrent preterm birth (PTB) prior to 35 weeks, was published in October of 2019. The objective of this study is to assess use of 17-OHP before and after the publication of PROLONG and whether there was any change in the rate of recurrent PTB.

17-P for Women With Congenital Uterine Anomalies: Does it Impact Preterm Birth Risk? [01K

INTRODUCTION: The effectiveness of 17P in the prevention recurrent of preterm birth (PTB) among women with congenital uterine anomalies (CUA) is unknown. This study evaluate association between 17P and delivery gestational age among women with CUA and a previous spontaneous PTB. METHODS: This study is a retrospective cohort of women with CUA who delivered at 2 health systems from 2013-2019. Women with ≥1 prior spontaneous PTB carrying non-anomalous, singleton gestations were included. The primary outcome was delivery gestational age. Secondary outcomes included delivery <37 and <34 weeks. Women receiving 17P were compared to those who did not receive 17P using Wilcoxon rank sum, Fisher’s exact, and chi-square. RESULTS: Of the 48 women with prior PTB, 11 (22.9%) received 17P. Demographic, medical, and obstetric characteristics were similar between women who did and did not get 17P. The subtype of CUA was also similar by 17P status. The initial cervical length was more than 35mm in both groups and did not differ, nor did rates of PPROM (25% vs 12.5%, 0.63). The median delivery gestational age was similar between groups [37.7 (IQR 30.7-38.3) vs. 37.1 (IQR 31-38.4) weeks] for those who did and did not receive 17P, respectively. Rates of recurrent PTB 0.99) and 0.99) were also similar in those who did and did not receive 17P. CONCLUSION: In this cohort of women with prior PTB and CUA, recurrent PTB was common, and though 17P was used in fewer than 1 in 4 women, use of 17P did not appear to impact this risk.

Cervical Length Screening Versus History-Indicated Cerclage in Women With Prior Early Preterm Birth [08K

INTRODUCTION: The objective of this study was to compare the rate of recurrent preterm birth (PTB) <37 weeks in women with prior early PTB who underwent history-indicated (HI) cerclage versus cervical length (CL) screening with cerclage when indicated. METHODS: This retrospective cohort study included women with a singleton pregnancy and a prior spontaneous PTB between 16w0d and 27w6d weeks. The primary outcome was PTB <37 weeks; secondary outcomes included PTB <34 and <28 weeks, spontaneous PTB, and NICU admission. Fisher exact tests and Wilcoxon rank-sum tests were used to compare baseline characteristics and in unadjusted analyses of the outcomes. Marginal logistic regression was used to adjust for confounders and account for women with multiple pregnancies during the study period. RESULTS: Among 357 women, 49 (14%) underwent HI cerclage and 308 (86%) underwent CL screening. HI cerclage patients presented to prenatal care earlier, delivered earlier in their prior pregnancies, and were more were more likely to have had a previous cerclage. Only 84 (27%) women who underwent CL screening required cerclage. Of the 49 women with HI cerclage, 26 (53%) had recurrent PTB versus 43% (n=132) in the CL screening group. The odds of PTB were not significantly different between the two groups (aOR 0.92, 95% CI 0.44-1.92, P=.82). Secondary outcomes did not differ significantly. CONCLUSION: Our results support preferential use of cervical screening for most women with prior early PTB, as it may avoid cerclage in 2/3 of women. This information is useful when counseling high-risk patients about management options.

Postpartum Long-Acting Reversible Contraception Is Associated With a Decrease in Recurrent Preterm Birth [3R

INTRODUCTION: A history of preterm birth is a major risk factor for subsequent preterm birth. The purpose of this study was to compare the rate of recurrent preterm birth in women who received postpartum long-acting reversible contraception (LARC) to those who did not receive postpartum LARC. METHODS: This is a retrospective cohort study of women with singleton gestations who delivered prior to 37 weeks between January 2011 and January 2015. The study was approved by the local IRB, and protected health information was de-identified. The rate of recurrent preterm birth was compared between women who received a LARC method within 12 weeks postpartum and those who did not receive LARC. Chi square analysis and multivariate logistic regression were performed controlling for maternal age, BMI, education, employment, race, ethnicity and insurance type. Interpregnancy interval was investigated as a secondary outcome. RESULTS: Of 355 subjects with preterm birth, 110 (31%) received postpartum LARC. The rate of recurrent preterm birth was 10.6% in the LARC group vs 23.4% in the non-LARC group (P=.006). After adjusting for potential confounders, subjects with postpartum LARC were 58% less likely to have a recurrent preterm birth as compared to subjects without postpartum LARC (adjusted 95% CI 0.20 - 0.86). The mean interpregnancy interval was 11.2 months longer in the LARC group as compared to the non-LARC group (P=.003). CONCLUSION: LARC placement within 12 weeks following a preterm birth is associated with a decreased risk of recurrent preterm birth. Contraceptive counseling in women with preterm birth should address this risk-reducing intervention.

Adjuvant administration of 17-α-hydroxy-progesterone caproate in women with three or more second trimester pregnancy losses undergoing cervical cerclage is no more effective than cerclage alone.

To investigate the role of adjuvant 17-α-hydroxy-progesterone caproate (17OHP-C) in reducing the risk of preterm delivery <34 weeks and adverse perinatal outcomes in women with ≥3 second trimester pregnancy losses attributed to cervical insufficiency undergoing prophylactic cerclage. Retrospective cohort study of women with prophylactic cerclage placed between 2006 and 2014 divided into a cohort of (i) those receiving adjuvant 17OHP-C (n=43), and (ii) controls with cerclage alone (n=59). Demographic characteristics were comparable in both groups. There was no significant difference in gestational age at delivery between the cerclage-17OHP-C group (33.4±5.6 weeks) and the cerclage-alone group (34.4±4.6 weeks); P=0.33. We noted a non-significant increase for deliveries <34 weeks in the cerclage-17OHP-C group (44.2%) compared to controls (28.8%) which remained non-significant after adjusting for confounders; P=0.46. There was no statistically significant difference in the rate of delivery <37, 32, 28 and 24 weeks. Adverse neonatal outcomes were comparable in both groups (cerclage-17OHP-C 48.8% vs. cerclage-alone 39%); P=0.43. Intramuscular 17OHP-C in combination with prophylactic cerclage in women with cervical insufficiency and ≥3 second trimester pregnancy losses had no synergistic effect in reducing the rate of recurrent preterm birth or improving perinatal outcomes.

Gestational age at initiation of 17-alpha hydroxyprogesterone caproate and recurrent preterm birth

Preterm birth is the leading cause of neonatal morbidity and mortality in nonanomalous neonates in the United States. Women with a previous early spontaneous preterm birth are at highest risk for recurrence. Weekly intramuscular 17-alpha hydroxyprogesterone caproate reduces the risk of recurrent prematurity. Although current guidelines recommend 17-alpha hydroxyprogesterone caproate initiation between 16 and 20 weeks, in clinical practice, 17-alpha hydroxyprogesterone caproate is started across a spectrum of gestational ages. The objective of the study was to examine the relationship between the gestational age at 17-alpha hydroxyprogesterone caproate initiation and recurrent preterm birth among women with a prior spontaneous preterm birth 16-28 weeks' gestation. This was a retrospective cohort study of women from a single tertiary care center, 2005-2016. All women with ≥1 singleton preterm births because of a spontaneous onset of contractions, preterm prelabor rupture of membranes, or painless cervical dilation between 16 and 28 weeks followed by a subsequent singleton pregnancy treated with 17-alpha hydroxyprogesterone caproate were included. Women were grouped based on quartiles of gestational age of 17-alpha hydroxyprogesterone caproate initiation (quartile 1, 140/7 to 161/7; quartile 2, 162/7 to 170/7; quartile 3, 171/7 to 186/7; and quartile 4, 190/7 to 275/7). Women with a gestational age of 17-alpha hydroxyprogesterone caproate initiation in quartiles 1 and 2 were considered to have early-start 17-alpha hydroxyprogesterone caproate; those in quartiles 3 and 4 were considered to have late-start 17-alpha hydroxyprogesterone caproate. The primary outcome was recurrent preterm birth <37 weeks' gestation. Secondary outcomes included recurrent preterm birth <34 and <28 weeks' gestation and composite major neonatal morbidity (diagnosis of grade III or IV intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, necrotizing enterocolitis stage II or III, or death). Gestational age at delivery was compared by quartile of 17-alpha hydroxyprogesterone caproate initiation using Kaplan-Meier survival curves and the log-rank test. Logistic regression models estimated odds ratios for the association between gestational age at 17-alpha hydroxyprogesterone caproate initiation and preterm birth <37 weeks' gestation, adjusting for demographics, prior pregnancy and antenatal characteristics. A total of 132 women met inclusion criteria; 52 (39.6%) experienced recurrent preterm birth <37 weeks in the studied pregnancy. 17-Alpha hydroxyprogesterone caproate was initiated at a mean 176/7 ± 2.5 weeks. Demographic and baseline characteristics were similar between women with early-start 17-alpha hydroxyprogesterone caproate (quartiles 1 and 2) compared with those with late-start 17-alpha hydroxyprogesterone caproate (quartiles 3 and 4). Women with early-start 17-alpha hydroxyprogesterone caproate trended toward lower rates of recurrent preterm birth <37 weeks compared with those with late-start 17-alpha hydroxyprogesterone caproate (41.3% vs 57.7%, P= .065). Delivery gestational age was inversely proportional to gestational age at 17-alpha hydroxyprogesterone caproate initiation (quartile 1, 374/7 weeks vs quartile 2, 365/7 vs quartile 3, 361/7 weeks vs quartile 4, 340/7, P= .007). In Kaplan-Meier survival analyses, these differences in delivery gestational age by 17-alpha hydroxyprogesterone caproate initiation quartile persisted across pregnancy (log-rank P < .001). In regression models, later initiation of 17-alpha hydroxyprogesterone caproate wassignificantly associated with increased odds of preterm birth <37weeks. Women with early 17-alpha hydroxyprogesterone caproate initiation also had lower rates of major neonatal morbidity than those with later 17-alpha hydroxyprogesterone caproate initiation (1.5% vs 14.3%, P= .005). Rates of recurrent preterm birth among women with a prior spontaneous preterm birth 16-28 weeks are high. Women beginning 17-alpha hydroxyprogesterone caproate early deliver later and have improved neonatal outcomes. Clinicians should make every effort to facilitate 17-alpha hydroxyprogesterone caproate initiation at 16weeks.

Pregnancy After Periviable Birth: Making the Case for Postpartum and Interpregnancy Care [27F

INTRODUCTION: Women with a history of a periviable birth are at risk for recurrent preterm delivery. We sought to determine postpartum follow up rates, interpregnancy intervals (IPI) and uptake of 17OHPC in women with prior periviable preterm births. METHODS: We used data from the Magee Obstetrical Medical and Infant Database from 2008-2014 to identify women with a periviable birth of a singleton gestation due to spontaneous preterm labor or PPROM between 20 and 26 weeks gestation. Chart abstraction was performed for women who had a subsequent delivery at our institution by the end of 2015. RESULTS: Of the 361 spontaneous periviable births at our institution, 63 (17.4%) women had a subsequent delivery. The rates of recurrent preterm birth (less than 34 weeks) and recurrent periviable birth were 27% and 12.7% respectively. 42.9% of women had an IPI of less than 12 months and only 55.8% of women returned for a postpartum visit (PPV) after their periviable delivery. In the subsequent pregnancy, 20.6% of women did not receive 17OHPC, most commonly because of late presentation to care. Women who did not return for their PPV were less likely to receive 17OHPC in the next pregnancy (57.1% vs 94.1%, p=0.001). CONCLUSION: Non-compliance with the PPV and short IPI were common in women with a prior periviable delivery. Compliance with the PPV was associated with higher rates of 17OHPC administration in the next pregnancy. These data suggest that strategies should be developed to improve postpartum care and counseling regarding risk reduction for women with a periviable birth.

Connect the Dots-March 2017.

Connect the Dots-March 2017.

17-alpha Hydroxyprogesterone caproate did not reduce the rate of recurrent preterm birth in a prospective cohort study

17-alpha Hydroxyprogesterone caproate for prevention of recurrent preterm birth is recommended for use in the United States. We sought to assess the clinical effectiveness of 17-alpha hydroxyprogesterone caproate to prevent recurrent preterm birth ≤35 weeks compared to similar births in our obstetric population prior to the implementation of 17-alpha hydroxyprogesterone caproate. This was a prospective cohort study of 17-alpha hydroxyprogesterone caproate in our obstetric population. The primary outcome was the recurrence of birth ≤35 weeks for the entire study cohort compared to a historical referent rate of 16.8% of recurrent preterm birth in our population. There were 3 secondary outcomes. First, did 17-alpha hydroxyprogesterone caproate modify a woman's history of preterm birth when taking into account her prior number and sequence of preterm and term births? Second, was recurrence of preterm birth related to 17-alpha hydroxyprogesterone caproate plasma concentration? Third, was duration of pregnancy modified by 17-alpha hydroxyprogesterone caproate treatment compared to a prior preterm birth? From January 2012 through March 2016, 430 consecutive women with prior births ≤35 weeks were treated with 17-alpha hydroxyprogesterone caproate. Nearly two thirds of the women (N= 267) began injections ≤18 weeks and 394 (92%) received a scheduled weekly injection within 10 days of reaching 35 weeks or delivery. Theoverall rate of recurrent preterm birth was 25% (N= 106) for the entire cohort compared to the 16.8% expected rate (P= 1.0). The 3 secondary outcomes were also negative. First, 17-alpha hydroxyprogesterone caproate did not significantly reduce the rates of recurrence regardless of prior preterm birth number or sequence. Second, plasma concentrations of 17-alpha hydroxyprogesterone caproate were not different (P= .17 at 24 weeks; P= .38 at 32 weeks) between women delivered ≤35 weeks and those delivered later in pregnancy. Third, the mean (±SD) interval in weeks of recurrent preterm birth before 17-alpha hydroxyprogesterone caproate use was 0.4 ± 5.3 weeks and the interval of recurrent preterm birth after 17-alpha hydroxyprogesterone caproate treatment was 0.1 ± 4.7 weeks (P= .63). A side effect of weekly 17-alpha hydroxyprogesterone caproate injections was an increase in gestational diabetes. Specifically, the rate of gestational diabetes was 13.4% in 17-alpha hydroxyprogesterone caproate-treated women compared to 8% in case-matched controls (P= .001). 17-alpha Hydroxyprogesterone caproate was ineffective for prevention of recurrent preterm birth and was associated with an increased rate of gestational diabetes.

Pregnancy Outcomes in Women With a History of Previable, Preterm Prelabor Rupture of Membranes.

To characterize subsequent pregnancy outcomes among women with a history of previable, preterm prelabor rupture of membranes (PROM) and assess factors associated with recurrent preterm birth. This was a retrospective cohort study of women cared for with a history of one or more singleton pregnancy complicated by preterm PROM at less than 24 weeks of gestation between 2002 and 2013 who were cared for in two tertiary care health systems by a single group of maternal-fetal medicine specialists. Women were identified using International Classification of Diseases, 9th Revision codes and obstetric databases. Those with iatrogenic preterm PROM and those whose index preterm PROM at less than 24 weeks of gestation was preceded by advanced cervical dilation were excluded. All women with one or more pregnancies reaching the second trimester after an index previable, preterm PROM pregnancy were included. The primary outcome was recurrent preterm birth at less than 37 weeks of gestation. Data were analyzed by χ, Fisher exact, t test, Wilcoxon rank-sum, and logistic regression. Two hundred ninety-four women had one or more pregnancies complicated by previable, preterm PROM. One hundred eight of 294 (37%) had one or more subsequent pregnancies in our health care systems and 50 of 108 (46%) had two or more. In the pregnancy immediately after the index delivery, the risk of prematurity was high: 50 (46%) delivered at less than 37 weeks of gestation, 31 (30%) at less than 34 weeks of gestation, 25 (23%) at less than 28 weeks of gestation, and 18 (17%) before 24 weeks of gestation. Fewer than half (n=49 [45%]) of women received preterm birth prophylaxis (progesterone or cerclage) in a subsequent pregnancy; rates of recurrent preterm birth were similar among women who received preterm birth prophylaxis compared with those who did not. In regression models, the only factor significantly associated with recurrent preterm birth at less than 37 weeks of gestation was a history of preterm birth preceding previable, preterm PROM delivery (adjusted odds ratio 3.23, 95% confidence interval 1.32-7.93). Patients with a history of previable, preterm PROM are at high risk of recurrent preterm birth.

Racial and ethnic disparities in use of 17-alpha hydroxyprogesterone caproate for prevention of preterm birth

Racial/ethnic disparities in preterm birth remain a major public health challenge in the United States. While 17-alpha hydroxyprogesterone caproate (17OHP-C) is recommended for preterm birth prevention in women with a prior preterm birth, non-Hispanic black women continue to experience higher rates of recurrent preterm birth than white women receiving the same treatment. Further investigation of disparities in 17OHP-C use and adherence is warranted. We sought to evaluate whether racial and ethnic disparities exist in the use of and adherence to 17OHP-C within a population of eligible women. This was a retrospective cohort study of women with a prior spontaneous, singleton preterm birth who were eligible for 17OHP-C for preterm birth prevention and received care at a single institution from 2010 through 2014. Associations between self-identified race/ethnicity (non-Hispanic black vs women in all other racial/ethnic groups) and documented counseling about 17OHP-C, receipt of any 17OHP-C, and adherence to 17OHP-C administration were each estimated by bivariable analysis and multivariable logistic regression. Adherence to 17OHP-C was defined as not >1 missed dose, initiation <20 weeks' gestational age, and continuation until 37 weeks or delivery. Of 472 women who were clinically eligible for 17OHP-C, 72% (N = 296) had documented 17OHP-C counseling and 48.9% (N = 229) received 17OHP-C. There were no differences in likelihood of 17OHP-C counseling or receipt of 17OHP-C based on race/ethnicity. While overall 83% (N = 176) of women were adherent to 17OHP-C, only 70% (N = 58) of non-Hispanic black women were adherent, compared to 91% (N = 118) of all other women (P < .001). Non-Hispanic black women had more missed doses (2.4 vs 0.4 doses, P < .001) and later initiation of care (12.0 vs 10.2 weeks, P < .001) than women in other racial/ethnic groups. After adjustment for potential confounders, non-Hispanic black women were significantly less likely to be adherent to 17OHP-C (adjusted odds ratio, 0.16; 95% confidence interval, 0.04-0.65). A significant interaction between non-Hispanic black race/ethnicity and public insurance was identified (adjusted odds ratio, 0.16; 95% confidence interval, 0.05-0.52). In a diverse cohort of women eligible for preterm birth prevention, non-Hispanic black women are at an increased risk of nonadherence to 17OHP-C. Non-Hispanic black women with public insurance are at a particularly increased risk of nonadherence.

Spontaneous Preterm Birth in African-American and Caucasian Women Receiving 17α-Hydroxyprogesterone Caproate

To determine if the rates of recurrent spontaneous preterm birth in women receiving 17α-hydroxyprogesterone caproate (17P) differ according to maternal race. Retrospective analysis of a cohort of women enrolled in outpatient 17P administration at < 27 weeks. Maternal characteristics, obstetric history, and rates of recurrent preterm birth were determined using chi-square and multivariable Cox proportional hazards regression at two-tailed α = 0.05. Primary study outcome was defined as having a spontaneous preterm birth < 34 weeks. African-American women initiated 17P injections later (19.6 versus 18.9 weeks, p < 0.001) and discontinued injections earlier (33.2 versus 34.1 weeks, p < 0.001) than Caucasian women. Spontaneous recurrent preterm birth < 34 weeks was higher in African-Americans versus Caucasians receiving 17P (odds ratio 2.1; 95% confidence interval 1.7, 2.4). After adjusting for other significant factors, African-American race retained the strongest association with recurrent spontaneous preterm birth < 34 weeks. Within each racial group, short cervical length < 25 mm before 27 weeks' gestation had the highest hazard of recurrent spontaneous preterm delivery. Despite treatment with 17P, African-American women have higher rates of recurrent preterm birth.

Rates of recurrent preterm birth by maternal body habitus in women receiving 17α-hydroxyprogesterone caproate

Objective: To examine the influence of maternal pre-pregnancy body mass index (BMI) on the rates of recurrent spontaneous preterm birth (SPTB) in women receiving 17α-hydroxyprogesterone caproate (17P).Methods: Retrospective analysis of a cohort of 6253 women with a singleton gestation and prior SPTB enrolled in 17P home administration program between 16.0 and 26.9 weeks. Data were grouped by pre-pregnancy BMI (lean <18.5 kg/m2, normal 18.5–24.9 kg/m2, overweight 25–29.9 kg/m2 and obese ≥30.0 kg/m2). Delivery outcomes were compared using χ2 and Kruskal–Wallis tests with statistical significance set at p < 0.05.Results: SPTB<28 weeks was significantly lower in normal weight women. Rates of recurrent SPTB<37 weeks were highest in the group with BMI<18.5 kg/m2. Lean gravidas were younger, more likely to smoke, and less likely to be African–American than those with normal or increased BMI. In logistic regression, after controlling for race and prior preterm birth <28 weeks, the risk of SPTB<37 weeks decreased 2% for every additional 1 kg/m2 increase in BMI.Conclusions: Recurrent spontaneous preterm delivery<37 weeks in patients on 17P is more common in lean women (BMI<18.5 kg/m2), and less common in obese women (BMI ≥30 kg/m2) suggesting that the current recommended dosing of 17 P is adequate for women with higher BMI.

Recurrent preterm birth in women treated with 17 α-hydroxyprogesterone caproate: the contribution of risk factors in the penultimate pregnancy

Objective: Examine rates of recurrent, spontaneous preterm birth (PTB) in women treated prophylactically with 17 α-hydroxyprogesterone caproate (17P) when the penultimate PTB was due to preterm labor (PTL) or preterm premature rupture of the membranes (pPROM). Methods: Retrospective, descriptive, database study of 1183 singleton gestations that initiated prophylactic 17P at <21 weeks with a penultimate PTB. Primary outcomes examined were rates of recurrent PTB at <37 and <32 weeks’ gestation in the PTL (n = 939) and pPROM (n = 244) cohorts. Results: Recurrent PTB <37 weeks occurred in 38% versus 28.3% of the PTL and pPROM cohorts, respectively (p <0.005). Rates of recurrent PTB <32 weeks were similar. Logistic regression revealed three risk factors increased the odds of recurrent PTB: >1 previous PTB (OR 1.8 [95% CI: 1.33–2.44]); penultimate birth at 28–33.9 weeks’ gestation (OR 1.61 [95% CI: 1.22–2.13]); and, PTL as the indication for delivery in the penultimate PTB (OR 1.66 [95% CI: 1.16–2.37]). Conclusion: Several historical factors increase the risk for recurrent PTB in women receiving 17P. Contrary to earlier studies of PTL and pPROM recurrence, women receiving prophylactic 17P with a penultimate PTB due to pPROM are at lower risk of recurrent PTB than those with a history of PTL.

17-alphahydroxyprogesterone caproate in women with previous spontaneous preterm delivery: does a previous term delivery affect the rate of recurrence?

The purpose of this study was to determine the role of previous term delivery on the rate of recurrent preterm birth in women with previous spontaneous preterm delivery (SPTD) who receive 17-alphahydroxyprogesterone caproate (17P) therapy. Women with singleton gestations who were receiving 17P therapy were studied. Rates of recurrent SPTD were compared for 1 or ≥2 SPTD with and without a previous term delivery. Five thousand one hundred two women had 1 previous SPTD, and 2217 women had ≥2 SPTDs. In women with 1 previous SPTD, a previous term delivery had lower rates of SPTD at <35 weeks (8.4% vs 11.2%; P = .002) and preterm delivery at <32 weeks (4.7% vs 6.2%; P = .027) compared with those women with no such history. No differences were found for SPTD at <35 weeks with ≥2 SPTDs. In patients who received 17P therapy with 1 previous SPTD, a previous term delivery confers a reduction in risk of preterm delivery at <37, <35, and <32 weeks' gestation; such reduction is not evident with ≥2 previous SPTDs.

A Trial of 17 Alpha-Hydroxyprogesterone Caproate to Prevent Prematurity in Twins

Background In singleton gestations, 17 alpha-hydroxyprogesterone caproate (17P) has been shown to reduce the rate of recurrent preterm birth. This study was undertaken to evaluate whether 17P would reduce the rate of preterm birth in twin gestations. Methods We performed a randomized, double-blind, placebo-controlled trial in 14 centers. Healthy women with twin gestations were assigned to weekly intramuscular injections of 250 mg of 17P or matching placebo, starting at 16 to 20 weeks of gestation and ending at 35 weeks. The primary study outcome was delivery or fetal death before 35 weeks of gestation. Results Six hundred sixty-one women were randomly assigned to treatment. Baseline demographic data were similar in the two study groups. Six women were lost to follow-up; data from 655 were analyzed (325 in the 17P group and 330 in the placebo group). Delivery or fetal death before 35 weeks occurred in 41.5% of pregnancies in the 17P group and 37.3% of those in the placebo group (relative risk, 1.1; 95% con...

Prophylaxis with 17 alpha-hydroxyprogesterone caproate for prevention of recurrent preterm delivery: does gestational age at initiation of treatment matter?

The purpose of this study was to determine effectiveness of 17 alpha-hydroxyprogesterone caproate (17 P) prophylaxis by gestational age (GA) at 17 P initiation. Singleton gestations with > or = 1 preterm birth (PTB) treated with 17 P prophylaxis for recurrent preterm birth before 27 weeks were identified from a data base. Data were stratified by GA at 17 P initiation (16-20.9 [n = 599] weeks and 21-26.9 [n = 307] weeks) and number of PTB (1, 2, > 2). Outcome variables were PTB at < 37, < 35, and < 32 weeks. No significant differences were found in gestational age at delivery or rates of recurrent PTB < 37, < 35, and < 32 weeks between those women initiating 17 P at 16-20.9 weeks or 21-26.9 weeks, or when stratified by number of prior preterm deliveries. Initiation of 17 P prophylaxis at 21-26.9 weeks is as effective as initiation at 16-20.9 weeks of gestation.

A Trial of 17 Alpha-Hydroxyprogesterone Caproate to Prevent Prematurity in Twins

In singleton gestations, 17 alpha-hydroxyprogesterone caproate (17P) has been shown to reduce the rate of recurrent preterm birth. This study was undertaken to evaluate whether 17P would reduce the rate of preterm birth in twin gestations. We performed a randomized, double-blind, placebo-controlled trial in 14 centers. Healthy women with twin gestations were assigned to weekly intramuscular injections of 250 mg of 17P or matching placebo, starting at 16 to 20 weeks of gestation and ending at 35 weeks. The primary study outcome was delivery or fetal death before 35 weeks of gestation. Six hundred sixty-one women were randomly assigned to treatment. Baseline demographic data were similar in the two study groups. Six women were lost to follow-up; data from 655 were analyzed (325 in the 17P group and 330 in the placebo group). Delivery or fetal death before 35 weeks occurred in 41.5% of pregnancies in the 17P group and 37.3% of those in the placebo group (relative risk, 1.1; 95% confidence interval [CI], 0.9 to 1.3). The rate of the prespecified composite outcome of serious adverse fetal or neonatal events was 20.2% in the 17P group and 18.0% in the placebo group (relative risk, 1.1; 95% CI, 0.9 to 1.5). Side effects of the injections were frequent in both groups, occurring in 65.9% and 64.4% of subjects, respectively (P=0.69), but were generally mild and limited to the injection site. Treatment with 17 alpha-hydroxyprogesterone caproate did not reduce the rate of preterm birth in women with twin gestations. (ClinicalTrials.gov number, NCT00099164 [ClinicalTrials.gov].).

Twin Gestations Remain Associated with Risk for Preterm Delivery

Weekly treatment with 17 alpha-hydroxyprogesterone caproate (17P) recently was shown to reduce the rate of recurrent preterm birth in singleton