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DOI: 10.1055/s-0039-1688776
Addressing Decision Making in Progesterone Treatment for History of Preterm Delivery
Publication History
24 February 2019
25 February 2019
Publication Date:
20 August 2019 (online)
![](https://www.thieme-connect.de/media/ajpr/201903/lookinside/thumbnails/10-1055-s-0039-1688776_190011-1.jpg)
Abstract
Introduction The United States ranks 27th among nations worldwide for infant mortality with a rate of 6.1 deaths per 1,000 live births. The majority of perinatal morbidity and mortality is related to preterm birth, defined as delivery prior to 37 weeks' gestation. Among the risk factors for preterm birth is prior preterm birth, which is associated with a 1.5- to 2.0-fold increase in risk. At the present time, there is only one Food and Drug Administration approved treatment for the prevention of preterm birth among women with a history of prior spontaneous premature delivery, intramuscular 17-α-hydroxyprogesterone caproate (17-OHP), administered once weekly from 20 to 36 weeks' gestation. However, many eligible pregnant patients decline this therapy.
Methods This was a prospective, cohort study involving patients who were identified as candidates for 17-OHP treatment at their first obstetric visit and asked to complete a short survey regarding their history of preterm birth. Those patients who consented to a follow-up phone call were asked to participate in a focus group discussion regarding their experience with progesterone and the health care system.
Results During the 1-year study period, 55 progesterone candidates were identified, 43 accepted treatment, 7 refused, and 5 either initiated prenatal care too late to receive injections or did not follow-up. Those who accepted treatment appeared to cope better with treatment side effects, and/or had traumatic emotional reactions regarding their prior premature birth outcomes. Women who declined treatment often cited pain with injection, had fatalistic beliefs regarding their care, and/or had personal concerns related to full-term pregnancy.
Discussion Maternal health care providers should always discuss the implications of prematurity at the time of the index premature delivery and again at the first prenatal visit of the subsequent pregnancy. Providers need to be prepared to employ various techniques for patient counseling and education. Small changes in office practice, like having fewer care providers involved in patient care or providing distractions for children, may make the difference between a patient who is open or closed to treatment options.
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References
- 1 MacDorman MF, Matthews TJ, Mohangoo AD, Zeitlin J. International comparisons of infant mortality and related factors: United States and Europe, 2010. Natl Vital Stat Rep 2014; 63 (05) 1-6
- 2 Mathews TJ, MacDorman MF. Infant mortality statistics from the 2013 period linked birth/infant data set. U.S. Department of Health and Human Services, Centers for Disease Control. Natl Vital Stat Rep 2014; 61 (08) 1-30
- 3 Kramer MS, Demissie K, Yang H, Platt RW, Sauvé R, Liston R. ; Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. The contribution of mild and moderate preterm birth to infant mortality. JAMA 2000; 284 (07) 843-849
- 4 Yee LM, Liu LY, Sakowicz A, Bolden JR, Miller ES. Racial and ethnic disparities in use of 17-alpha hydroxyprogesterone caproate for prevention of preterm birth. Am J Obstet Gynecol 2016; 214 (03) 374.e1-374.e6
- 5 Meis PJ, Klebanoff M, Thom E. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 2003; 348 (24) 2379-2385
- 6 Markham KB, Walker H, Lynch CD, Iams JD. Preterm birth rates in a prematurity prevention clinic after adoption of progestin prophylaxis. Obstet Gynecol 2014; 123 (01) 34-39
- 7 Ohio Department of Health Report on Low Birth Weight and Preterm Birth. 2014 . Available at: https://www.odh.ohio.gov/-/media/ODH/ASSETS/Files/data-statistics/maternal-and-child-health/wih_lowbirthweight.pdf?la=en . Retrieved March 26, 2018
- 8 Ribak R, Harlev A, Ohel I, Sergienko R, Wiznitzer A, Sheiner E. Refusal of emergency caesarean delivery in cases of non-reassuring fetal heart rate is an independent risk factor for perinatal mortality. Eur J Obstet Gynecol Reprod Biol 2011; 158 (01) 33-36
- 9 Ohel I, Levy A, Mazor M, Wiznitzer A, Sheiner E. Refusal of treatment in obstetrics - a maternal-fetal conflict. J Matern Fetal Neonatal Med 2009; 22 (07) 612-615
- 10 Callaghan WM, MacDorman MF, Rasmussen SA, Qin C, Lackritz EM. The contribution of preterm birth to infant mortality rates in the United States. Pediatrics 2006; 118 (04) 1566-1573
- 11 Ransom CE, Chin JR, Roeder HA, Sinclair TR, Heine RP, Murtha AP. The influence of prior obstetrical history on current 17-hydroxyprogesterone caproate use. J Pregnancy 2011; 2011: 286483
- 12 Schreier M. Qualitative Content Analysis in Practice. Thousand Oaks, CA: Sage Publications Ltd.; 2012