INTRODUCTION: Prior spontaneous preterm birth (sPTB) is a risk factor for recurrent sPTB. Weekly 17-hydroxyprogesterone caproate (17P) is used to prevent sPTB in singletons, but there is insufficient evidence on its benefit in twin pregnancies.
OBJECTIVE: We hypothesized that 17P weekly injections would reduce the likelihood of sPTB in women carrying a twin pregnancy with a history of singleton sPTB.
METHODS: We performed a retrospective case control study of women with a twin gestation and prior singleton sPTB between 2005 and 2016. The study group consisted of women with a twin gestation that received weekly 17P starting at 16 to 20 weeks versus those who did not. The primary outcome was twin sPTB discharge.
RESULTS: Of 79 patients included, 27 women received weekly 17P and 52 did not. There were no statistically significant differences in maternal demographics (except maternal age) or in the rate of sPTB controls. There was no statistically significant difference in the rate of sPTB weeks, mean birth weight, or mode of delivery between study and control groups. Composite neonatal morbidity occurred in 20 neonates (74%) in the study group and in 41 control pregnancies (79%).
DISCUSSION: Weekly 17P injections do not appear to decrease the incidence of sPTB or neonatal complications in twin pregnancies with a history of prior singleton sPTB. This study will therefore guide future patient management on this common obstetric dilemma.
Valcarcel, Breanna; Ward, Andrew; Al-Kouatly, Huda; Berghella, Vincenzo; and Greenberg, Victoria, "17-Hydroxyprogesterone Caproate Does Not Prevent Preterm Birth in Women with a Twin Pregnancy and a Prior Singleton Spontaneous Preterm Birth" (2019). SKMC JeffMD Scholarly Inquiry, Phase 1, Project 1.
Available for download on Friday, January 24, 2020