The Society for Maternal-Fetal Medicine (SMFM) has released a statement addressing the use of 17-alpha hydroxyprogesterone caproate (17-OHPC) therapy to prevent preterm birth (PTB) out of concern that women who are eligible are not receiving the medication appropriately. Specific attention has been given to route of delivery (intramuscular vs. vaginal). In the statement, the SMFM provides the data review upon which these recommendations are based and recommends the following:
Given the available data, this SMFM statement reaffirms its current recommendations: In women with singleton gestation and a history of prior spontaneous PTB between 20 weeks of gestation and 36 6/7 weeks of gestation, we recommend 17-OHPC at 250 mg IM weekly starting at 16-20 weeks of gestation until 36 weeks of gestation or delivery and vaginal progesterone should not be considered a substitute for 17-OHPC in these patients.
SMFM continues to affirm the use of vaginal progesterone to prevent preterm birth in women with sonographically short cervix < 20mm without a history of prior spontaneous PTB.
The Oklahoma Health Care Authority has developed a coverage algorithm for providers of SoonerCare patients that is in alignment with the SMFM statement. OHCA also has a Guideline for Provision of Progesterone Prophylaxis of Preterm Birth.
Read the SMFM statement here (ahead of print): http://www.ajog.org/pb/assets/raw/Health%20Advance/journals/ymob/YMOB_11500.pdf
- OPQIC: Oklahoma Preterm Birth Initiative
- SMFM: Routine Cervical Length Screening
- OHCA: Progesterone Guidelines
- OHCA: Progesterone Coverage Algorithm
- ACOG: Practice Bulletin #130: Prediction and Prevention of Preterm Birth
Reference: SMFM Publications Committee, SMFM Statement: The choice of progestogen for the prevention of preterm birth in women with singleton pregnancy and prior preterm birth, American Journal of Obstetrics and Gynecology (2017), doi: 10.1016/j.ajog.2017.01.022.