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17P Plus Cerclage Decreases Preterm Labor Risk

May 6, 2013

New Orleans, LA -- Pregnant women at risk of preterm labor who have their cervix stitched closed may increase their chances of carrying a fetus to term by also receiving injections of 17P, according to research presented today at the Annual Clinical Meeting of The American College of Obstetricians and Gynecologists.

The cervix is stitched closed in a minor surgery known as “cerclage.” 17P (17 alpha-hydroxyprogesterone) is a progesterone-based hormone given to pregnant women at high risk for preterm birth. It is available as a gel or an injectable.

A small study, lead by Lorene Temming, MD, at Carolinas Medical Center in Charlotte, NC, looked at 123 women from 2009 to 2011. It found that pregnant women receiving cerclage alone were 22 times more likely to experience preterm birth before 34 weeks’ gestation than those given cerclage plus 17P.

Cerclage is often performed on pregnant women with a history of multiple second-trimester losses who have painless cervical dilation and deliver early, a condition called cervical insufficiency. Other studies have shown 17P prevents recurrent preterm birth in women with a history of preterm birth.

“Preterm birth is a spectrum of disease, and preterm labor as well as cervical insufficiency, are both on this spectrum,” said Dr. Temming. “Preterm labor is typically treated with weekly injections of 17P, and cervical insufficiency is typically treated with cerclage. I wanted to see if the addition of 17P to people treated with cerclage showed improved outcomes,” Dr. Temming added.

According to Dr. Temming, the results are surprising because other studies have not shown a statistically significant benefit of adding 17P treatment to cerclage, though some showed a trend toward decreased rates of preterm labor with the addition of 17P.

Women in Dr. Temming’s study had cerclage for various reasons, but a large percentage were emergency cerclage. Dr. Temming said this could account for some of the differences between her study and others because this group may reflect a population with more significant risk.

*Monday Poster #78: Cerclage Alone vs. Cerclage and 17P for the Prevention of Preterm Birth

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org

 

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