In the name of God. The effect of intramuscular progesterone on the rate of cervical shortening. Cara Pessel , MD et al American Journal of Obstetrics and Gynecology 2013.
Cara Pessel, MD et al
American Journal of Obstetrics and Gynecology
The purpose of the study was: evaluate whether17-alpha-hydroxyprogesterone caproate (17-OHPC) exposure isassociated with the rate of cervical shortening.
pregnancy has proved to be a useful
tool in the identification of women who
Are at risk of spontaneous preterm delivery.
and weekly intramuscular injections of
cervical length decreases withadvancing gestational age and that the cervix begins to shorten physiologically after 28 weeks’ gestation, even in womenwho are destined to deliver at term
mechanism by which 17-OHPC reduces the risk of recurrent preterm delivery is not well established.
aberrations in cervical remodeling may predispose women to recurrent preterm deliveries and progesterone may function by targeting these aberrations, we hypothesized that women who experience recurrent preterm delivery and were exposed to progesterone may exhibit a slower rate of cervical shortening when compared with women who were not exposed to 17-OHPC.
a retrospective study among women with history of spontaneous preterm delivery (defined as 1 spontaneous births between 16
weeks and 36 weeks 6 days’ gestation)
who underwent serial cervical length
assessments to monitor for cervical
shortening in our institution between
2009 and 2012
1.major fetal anomalies,
2.vaginal progesterone use at any time
in the index pregnancy,
3.<2 cervical length measurements
4.medically indicated preterm delivery, or
5.the presence or placement of an abdominal or vaginal cerclage
Electronic medical records were reviewed to abstract pertinent obstetric history, including the number of previous preterm deliveries, gestational age of each preterm delivery, and whether that pregnancy involved multiple gestations.
delivery, type of provider (private maternal-fetal medicine specialist, private generalist obstetrician and gynecologist
(OB/GYN), or government-insured OB/GYN low-risk clinic or high-risk maternal-fetal medicine clinic), use of in vitro fertilization, smoking status, and illicit drug use during pregnancy.
At our center, women with a history ospontaneousdelivery at <37 weeks’ gestation are offered weekly treatment with 17-OHPC starting at 16 gestational weeks.
guidelines at Columbia University
Medical Center require 3 measurements
of the cervix that include at least 1
assessment while the patient performs
the Valsalva maneuver. The shortest of
the 3 cervical length values is reported
clinically; this measurement was recorded
into our database for each visit
as <25 mm, which represents the
10th percentile at 24 weeks’ gestation.
Once this is identified in our ultrasound
unit, patient treatment varies
according to practitioner and individual
patient details and may involve cerclage
placement, the initiation of vaginal
progesterone, or expectant treatment
all women who may benefit from timesensitive
interventions such as antenatal
steroid and magnesium administration
major fetal anomalies, 5 women; the presence
of placement of a cerclage (2 abdominal
and 78 vaginal), 80 women; exposure to
vaginal progesterone, 32 women; indicated
preterm delivery, 22 women.
Women who were exposed to 17-OHPC were, on average, 2.2 years younger None of the other characteristics, including previous uterine or cervical surgery, differed between the groups.
The first cervical length measurements (41.6 vs 40.7 mm; P ¼.52) were similar, regardles of 17-OHPC exposure. The number of cervical length measurements was higher in women who wereexposed to 17-OHPC (median of 5 exams vs 3 in those who were not exposed to 17-OHPC; P <.01).
The average rates of cervical shortening per week among term deliveries were 0.9 and 0.8 mm
with and without 17-OHPC, respectively
(P ¼ .76). Among preterm deliveries,
the corresponding rates were 0.8 and
1.2 mm, respectively, among women
with and without 17-OHPC (P ¼.67).
current pregnancy on exposure to 17-OHPC did not differ based.