Adjuvant administration of 17-α-hydroxy-progesterone caproate in women with three or more second trimester pregnancy losses undergoing cervical cerclage is no more effective than cerclage alone.

Autor:	Samson FD; Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA., Merriman AL; Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, USA., Tate DL; Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA., Apostolakis-Kyrus K; Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA., Gomez LM; Perinatal Associates of Northern Virginia, Inova Health System, Maternal Fetal Medicine, 3300 Gallows Road, Falls Church, VA, 22042, USA, Tel.: +1 (703) 776-2745, Fax: +1 (703) 776-6443.
Jazyk:	angličtina
Zdroj:	Journal of perinatal medicine [J Perinat Med] 2018 Feb 23; Vol. 46 (2), pp. 155-161.
DOI:	10.1515/jpm-2017-0074
Abstrakt:	Objective: To investigate the role of adjuvant 17-α-hydroxy-progesterone caproate (17OHP-C) in reducing the risk of preterm delivery <34 weeks and adverse perinatal outcomes in women with ≥3 second trimester pregnancy losses attributed to cervical insufficiency undergoing prophylactic cerclage. Material and Methods: Retrospective cohort study of women with prophylactic cerclage placed between 2006 and 2014 divided into a cohort of (i) those receiving adjuvant 17OHP-C (n=43), and (ii) controls with cerclage alone (n=59). Results: Demographic characteristics were comparable in both groups. There was no significant difference in gestational age at delivery between the cerclage-17OHP-C group (33.4±5.6 weeks) and the cerclage-alone group (34.4±4.6 weeks); P=0.33. We noted a non-significant increase for deliveries <34 weeks in the cerclage-17OHP-C group (44.2%) compared to controls (28.8%) which remained non-significant after adjusting for confounders; P=0.46. There was no statistically significant difference in the rate of delivery <37, 32, 28 and 24 weeks. Adverse neonatal outcomes were comparable in both groups (cerclage-17OHP-C 48.8% vs. cerclage-alone 39%); P=0.43. Conclusion: Intramuscular 17OHP-C in combination with prophylactic cerclage in women with cervical insufficiency and ≥3 second trimester pregnancy losses had no synergistic effect in reducing the rate of recurrent preterm birth or improving perinatal outcomes.
Databáze:	MEDLINE
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