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27: 17 alpha-hydroxyprogesterone caproate in women with previous preterm delivery: does a previous term delivery influence effectiveness?

      Objective

      To determine whether 17 alpha-hydroxyprogesterone caproate (17P) is equally effective when given to women with a history of spontaneous preterm delivery with or without a concomitant term delivery.

      Study Design

      Women enrolled in an outpatient 17P administration program with singleton gestations and a history of spontaneous preterm delivery initiating 17P at <25 weeks were studied. Maternal characteristics and the rates of recurrent spontaneous preterm delivery were compared for women with ≥1 spontaneous preterm delivery with and without history of at least one prior term delivery. Outcomes were compared using Chi square and logistic regression analysis.

      Results

      A total of 5102 had 1 previous spontaneous preterm delivery and 2217 had >1 spontaneous preterm delivery. In women with only 1 prior spontaneous preterm delivery, those with a history of a term delivery had significantly lower rates of recurrent spontaneous preterm delivery at <35 and <32 weeks compared to those without such a history. In contrast, no such differences were found in those women with >1 prior spontaneous preterm delivery (Table, SPTD = spontaneous preterm delivery, RSPTD = recurrent spontaneous preterm delivery). Logistic model results adjusting for confounding factors with recurrent spontaneous preterm delivery <37 week as dependent variable for 1 prior spontaneous preterm delivery revealed a history of prior term birth remained significantly associated with lower rate of recurrent spontaneous preterm delivery (p=0.009); a marginal association was found for those with >1 prior spontaneous preterm delivery (p=0.057).
      Tabled 1
      Previous Term1 Prior SPTD>1 Prior SPTD
      YesNoYesNo
      # of patients157935237291488
      GA at 17P start (wk)18.8 ± 2.418.7 ± 2.419.0 ± 2.518.9 ± 2.5
      Total injections 17P15.9 ± 4.315.9 ± 4.314.9 ± 4.815.1 ± 4.7
      RSPTD <37 wk (%)23.927.5
      =p<0.05,
      33.528.9
      =p<0.05,
      RSPTD <35 wk (%)8.411.2
      =p<0.005,
      16.217.5
      RSPTD <32 wk (%)3.95.2
      =p=0.05
      7.57.9
      low asterisk =p<0.05,
      low asterisklow asterisk =p<0.005,
      low asterisklow asterisklow asterisk =p=0.05

      Conclusions

      In patients receiving 17P because of a history of 1 prior spontaneous preterm delivery, a previous term delivery confers a reduction in risk for recurrent preterm delivery at <37, <35 and <32 weeks' gestation, however such reduction in risk is not evident for those patients with history of >1 prior spontaneous preterm delivery.