What we have learned about the role of 17-alpha-hydroxyprogesterone caproate in the prevention of preterm birth.
Despite major advances in neonatal care, the burden of preterm birth remains high. This is not unexpected since strategies to identify and treat risk factors in early pregnancy have not been very effective in reducing the preterm birth rate. Initial studies suggested a potential benefit for 17-alpha-hydroxyprogesterone caproate (17-OHPC) in decreasing the risk of recurrent preterm birth women with a singleton gestation. However, the use of 17-OHPC has not conferred benefit for other categories of women at high risk for preterm delivery (twins, triplets, and short cervical length). The increasing body of evidence suggests that preterm birth is a complex condition with variable mechanisms of disease and significant individual heterogeneity. This review will examine the plausibility of 17-OHPC in preventing preterm birth and the investigation of its clinical efficacy. We will also highlight factors to explain variations in clinical trial outcomes and outline the trajectory needed for future investigations.
Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: carisn@mail.magee.edu.
Steve N
SN
Caritis
Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Maisa N
MN
Feghali
Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
William A
WA
Grobman
Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI.
Dwight J
DJ
Rouse
D000077713:17 alpha-Hydroxyprogesterone Caproate; D000328:Adult; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000187:drug effects* / Q000473:pathology; D004965:Estrogen Antagonists / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D005260:Female; D005865:Gestational Age; D006801:Humans; D006908:Hydroxyprogesterones / Q000627:therapeutic use*; D007231:Infant, Newborn; D011247:Pregnancy; D011272:Pregnancy, Multiple; D047928:Premature Birth / Q000188:drug therapy / Q000517:prevention & control; D011374:Progesterone / Q000627:therapeutic use*; D011372:Progestins / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D016896:Treatment Outcome
D004965:Estrogen Antagonists; D006908:Hydroxyprogesterones; D011372:Progestins; D000077713:17 alpha-Hydroxyprogesterone Caproate; D011374:Progesterone
17-alpha-hydroxyprogesterone caproate; Preterm birth; Prevention