The Use of 17 Alpha-Hydroxyprogesterone Caproate (17P) in Women with Cervical Cerclage

Abstract

Our objective was to compare the incidence of recurrent spontaneous preterm delivery (SPTD) in patients with cervical cerclage treated with weekly 17 alpha-hydroxyprogesterone caproate (17P) injections versus daily outpatient nursing surveillance (ONS) without 17P. Included in this retrospective cohort study were singleton gestations with cerclage placed at the discretion of the provider due to prior SPTD, delivering between January 1, 2004 and May 1, 2006. The study group (n = 232) consisted of women receiving once-weekly nursing visit and 17P injection. The control group (n = 1650) consisted of women enrolled for ONS (twice-daily electronic uterine contraction monitoring and nursing assessment). Data were further stratified by the number of prior preterm deliveries (1, > 1). Primary study outcome was the incidence of SPTD. No difference in rates of recurrent SPTD at < 37 or < 35 weeks were observed between the study and control groups. Study patients were less likely to be diagnosed with preterm labor (PTL) than controls (45.7% versus 70.8%, respectively; P < 0.001). The incidence of preterm premature rupture of membranes was similar between the groups (8.6% versus 8.1%; P = 0.770). We concluded that the incidence of recurrent SPTD was similar in women with cerclage treated with 17P or ONS, although women receiving 17P had a lower incidence of PTL. This benefit of 17P should be considered when managing patients with prior SPTD and cerclage.

Progestins and Preterm Birth

“…Rafael et al , in a retrospective cohort study of 58 women with CL of < 25 mm at < 23 6/7 weeks' gestation, found that there was no significant differences in the incidences of spontaneous PTB < 35, < 32, or < 28 weeks' among women with a ultrasound indicated cerclage, regardless of whether or not they received 17OHP-C (15 in the 17OHP-C group vs. 43 in the no 17OHP-C group) during the current pregnancy. Their findings are similar to the results of two other studies concerning 17OHP-C in women with a cerclage in place (Berghella et al, 2010 andRebarber et al, 2008).…”

Adjunctive Therapies to Cerclage for the Prevention of Preterm Birth: A Systematic Review

“…Our review identified 6 studies that compared the use of progesterone plus cerclage to a reference group of women who received cerclage without progesterone [2–7]. All 6 studies used the synthetic progestin 17- α OHPC, and none utilized vaginal progesterone or systemic administration of bioidentical progesterone.…”

17-alpha-hydroxyprogesterone caproate for the prevention of preterm birth in women with prior preterm birth and a short cervical length

“…A prior study (16) reported the effect of 17P in women with cerclage, but could not distinguish between cerclage placed for history- or ultrasound- or even physical exam-indications. Another strength is the use of 17P was actually confirmed with measure of compliance.…”