OB-GYN-L Messages for December, 2005: Re: 17P

Re: 17P

From: Dr. Ainsworth

ainsron@sbcglobal.net

Wed Dec 7 10:25:38 2005

17 Hydroxyprogesterone for the Prevention of Preterm Delivery Paul J. Meis, MD for the Society for Maternal–Fetal Medicine >From the Department of Obstetrics and Gynecology, Maternal–Fetal
Medicine, Winston-Salem, North Carolina.

The recent publication of 2 large randomized trials of 17 alpha hydroxyprogesterone caproate (17P) and progesterone suppositories, respectively, for the prevention of premature labor have renewed interest in the use of progesterone to prevent preterm birth. The results of these trials have reinforced the positive results of earlier smaller trials of 17P to prevent preterm delivery. A large body of evidence attests to the lack of teratogenic effects of 17P in pregnancy. Although progesterone is known to have many actions beneficial to the maintenance of pregnancy, the exact mode of action of 17P therapy in preventing preterm labor and delivery is not known. Current evidence supports the use of 17P treatment, begun early in the second trimester of gestation and continued weekly until 36 weeks, for women with a history of a previous spontaneous preterm delivery. At present no evidence exists for the use of 17P to prevent preterm delivery in women with multiple gestation, a short uterine cervix, or other high-risk conditions. The use of 17P or other progestins should not be encouraged for these indications outside of randomized trials. At present no evidence exists for the efficacy of any oral progesterone compound in preventing preterm labor. Four trials reporting the use of a progestational drug in patients with symptoms of preterm labor found no efficacy in prolonging pregnancy, and the use of 17P or other progestational drugs as tocolytic therapy should not be encouraged.

In the body of his commentary, he also states that it should be offered to women with hx of PROM with preterm delivery.

At Wed, 07 Dec 2005, Andrew Folley wrote: >
>Some controversy exists as to whether it works at all. Qustions regarding
>Meis original studyies. New research going on for use of 17 OH cream in
>vagina. andy
>
>>From: ainsron@sbcglobal.net (Dr. Ainsworth)
>>Reply-To: ob-gyn-l@obgyn.net
>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>>Subject: 17P
>>Date: Tue, 6 Dec 2005 23:52:15 -0600
>>
>>For those of you using or considering 17P for patients with Hx of
>>preterm labor, How would you use it in which of the following
>>circumstances?:
>>
>>1. 25 yo G3 P1102, history of first pregnancy at 40 wks, no
>>complications, no PTL; second pregnancy at 36 weeks, PROM, followed by
>>spontaneous labor.
>>
>>2. 25 yo G3 P1102, history of first pregnancy complicated by PTL from
>>30 weeks; delivery at 35 weeks, second pregnancy delivery at 39 weeks,
>>no PTL, not given 17P.
>>
>>3. 25 yo G3 P1102, history of term delivery at 39 weeks; second
>>pregnancy PTL from 30 weeks, delivery at 36 weeks.
>>
>>4. 25 yo G3 P2002, history of term delivery at 39 weeks; second
>>pregnancy PTL from 30 weeks, delivery at 39 weeks.
>>
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