Progesterone for prevention of recurrent preterm birth: Impact of gestational age at previous delivery

Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17-alpha hydroxyprogesterone caproate (17-OHP caproate) has been found to be efficacious in reducing the risk of subsequent preterm delivery in women who have had a previous spontaneous preterm birth (s...

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Veröffentlicht in:American journal of obstetrics and gynecology 2005-09, Vol.193 (3), p.1127-1131
Hauptverfasser: Spong, Catherine Y., Meis, Paul J., Thom, Elizabeth A., Sibai, Baha, Dombrowski, Mitchell P., Moawad, Atef H., Hauth, John C., Iams, Jay D., Varner, Michael W., Caritis, Steve N., O'Sullivan, Mary J., Miodovnik, Menachem, Leveno, Kenneth J., Conway, Deborah, Wapner, Ronald J., Carpenter, Marshall, Mercer, Brian, Ramin, Susan M., Thorp, John M., Peaceman, Alan M., Gabbe, Steven
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Sprache:eng
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Zusammenfassung:Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17-alpha hydroxyprogesterone caproate (17-OHP caproate) has been found to be efficacious in reducing the risk of subsequent preterm delivery in women who have had a previous spontaneous preterm birth (sPTB). This analysis was undertaken to evaluate if 17-OHP caproate therapy works preferentially depending on the gestational age at previous spontaneous delivery. We hypothesized that treatment with 17-OHP caproate is more effective in prolonging pregnancy depending on the gestational age of the earliest previous preterm birth (20-27.9, 28-33.9 vs 34-36.9 weeks). This was a secondary analysis of 459 women with a previous sPTB enrolled in a randomized controlled trial evaluating 17-OHP caproate versus placebo. Effectiveness of 17-OHP caproate for pregnancy prolongation was evaluated based on gestational age at earliest previous delivery according to clinically relevant groupings (20-27.9, 28-33.9, and 34-36.9 weeks). Statistical analysis included the chi-square, Fisher exact, and Kruskal-Wallis tests, logistic regression, and survival analysis using proportional hazards. Gestational age at earliest previous delivery was similar between women treated with 17-OHP caproate or placebo ( P = .1). Women with earliest delivery at 20 to 27.9 weeks and at 28 to 33.9 weeks delivered at significantly more advanced gestational age if treated with 17-OHP caproate than with placebo (median 37.3 vs 35.4 weeks, P = .046 and 38.0 vs 36.7 weeks, P = .004, respectively) and were less likely to deliver
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2005.05.077