title: 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.
authors.affiliation: Division of Maternal Fetal Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
authors.forename: Andrei
authors.initials: A
authors.lastname: Rebarber
authors.forename: Jane
authors.initials: J
authors.lastname: Cleary-Goldman
authors.forename: Niki B
authors.initials: NB
authors.lastname: Istwan
authors.forename: Debbie J
authors.initials: DJ
authors.lastname: Rhea
authors.forename: Cheryl
authors.initials: C
authors.lastname: Desch
authors.forename: Karen
authors.initials: K
authors.lastname: Russo-Stieglitz
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Saltzman
mesh_terms: D000077713:17 alpha-Hydroxyprogesterone Caproate; D000328:Adult; D023802:Cerclage, Cervical; D015331:Cohort Studies; D004965:Estrogen Antagonists / Q000627:therapeutic use*; D005260:Female; D005865:Gestational Age; D006801:Humans; D006908:Hydroxyprogesterones / Q000627:therapeutic use*; D009732:Nursing Care; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
chemical_list: D004965:Estrogen Antagonists; D006908:Hydroxyprogesterones; D000077713:17 alpha-Hydroxyprogesterone Caproate