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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.

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the effect of intramuscular progesterone on the rate of cervical shortening

The effect of intramuscular progesterone on the rateof cervical shortening

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.

  • Cervical length measurement in

pregnancy has proved to be a useful

tool in the identification of women who

Are at risk of spontaneous preterm delivery.

  • Serial assessments of the cervix

and weekly intramuscular injections of

17-alpha-hydroxyprogesterone caproate



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.

  • A previous study reported no difference in the rate of cervical shortening among women with a history of spontaneous preterm delivery according to 17-OHPC exposure.

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.

materials and methods

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


Pregnancies with

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

were excluded.


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.

  • maternal age, race,ethnicity, prepregnancy and weight at

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.

  • Review of our electronic ultrasound database was used to record cervical length measurements (in millimeters) from 16-32 weeks’ gestation

The obstetrics ultrasound

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


Short cervix is defined at our institution

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

and observation


the goal of our protocol was to identify

all women who may benefit from timesensitive

interventions such as antenatal

steroid and magnesium administration

  • Of 17,400 deliveries from 2009-2012, 376 women with a history of spontaneous preterm delivery met inclusion criteria.
  • We excluded 139 women:

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.

  • This resulted in 237 women for analysis. Of the included patients, 184 (77.6%) were exposed to 17-OHPC in the current pregnancy.

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.

  • Subjects who were not exposed to 17-OHPC were more likely to have a previous preterm delivery that involved a multiple gestation
  • obstetric history of recurrent preterm delivery, gestational age at earliest preterm delivery, and history of at least 1 term delivery was similar between those who were exposed to 17-OHPC and those not.

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).


Rates of spontaneous preterm delivery in the

current pregnancy on exposure to 17-OHPC did not differ based.