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DOI: 10.1055/s-0040-1721713
Recurrent Preterm Birth Reduction by 17-Hydroxyprogesterone Caproate in Dichorionic/Diamniotic Twin Gestation
Funding S.N.C. and R.V. have received funding from AMAG Pharmaceuticals to evaluate bioequivalence of intramuscular and subcutaneous 17-OHPC in pregnant women. AMAG Pharmaceuticals is supplying 17-OHPC for the Obstetrical-Fetal Pharmacology Research Centers study of 250 versus 500 mg 17-OHPC which is headed by S.N.C.![](https://www.thieme-connect.de/media/ajp/202211/lookinside/thumbnails/10-1055-s-0040-1721713_200688-1.jpg)
Abstract
Objective The study aimed to evaluate the impact of 17-hydroxyprogesterone caproate (17-OHPC) on recurrent preterm birth (PTB) in women with a prior PTB and a current dichorionic/diamniotic twin gestation.
Study Design We combined individual patient-level data from two prospective randomized placebo-controlled trials of prophylactic 17-OHPC in twin gestation and compared the rates of recurrent spontaneous PTB in those women with a prior singleton PTB randomized to placebo or 17-OHPC (250 mg weekly).
Results Only 7.4% of women with dichorionic/diamniotic twin gestation experienced a prior PTB. Among these 66 women, spontaneous delivery prior to 34 weeks occurred significantly less often (p = 0.03) in those randomized to 17-OHPC (20.6%) than in those randomized to placebo (46.9%). However, mean gestational length was not significantly different, and there was no statistically significant difference in composite neonatal outcome.
Conclusion 17-OHPC may be beneficial to women with a prior PTB and a current dichorionic/diamniotic twin gestation. These findings along with those reported by the Maternal Fetal Medicine Units Network in singletons suggest a common mechanism of action and a specific target population, those with a prior PTB, that may benefit from 17-OHPC treatment. A large prospective trial is needed to validate these findings.
Key Points
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17-OHPC reduces recurrent PTB in women with dichorionic/diamniotic twins.
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PTB risk and response to 17-OHPC may differ according to the type of twinning.
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17-OHPC may affect a common pathway in twins and singletons with a prior PTB.
Publication History
Received: 03 August 2020
Accepted: 04 November 2020
Article published online:
15 December 2020
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