January 19th, 2020

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Vaginal Versus Intramuscular Progestogen for Prevention of Recurrent Spontaneous Preterm Birth: A Pragmatic Study in a High-Risk Patient Population
Authors:  Tanya L. Glenn, M.D., Rose A. Maxwell, Ph.D., M.B.A., and David S. McKenna, M.D.
  OBJECTIVE: To evaluate whether vaginal progestogen (VP) can be substituted for intramuscular (IM) progestogen for the prevention of recurrent spontaneous preterm delivery in a residency based high-risk obstetric clinic.

STUDY DESIGN: Retrospective study comparing delivery <37 weeks in women with a history of spontaneous preterm birth (SPTB) receiving vaginal versus IM progestogen. Outcomes were obtained via electronic medical record.

RESULTS: There was no significant difference between the IM (n=36) and VP (n=28) groups for delivery <37 weeks (23.5% vs. 46.4%, p=0.067). A statistically significant increase in the number of additional gestational days compared to their earliest SPTB was seen in individuals with 17α-hydroxyprogesterone caproate (17α-OHP) versus VP (9.0±5.8 days vs. 5.3±6.0 days; p=0.036). There were no differences between the groups for other secondary outcomes.

CONCLUSION: Our study supports the use of either VP or 17α-OHP for prevention of SPTB; however, there was an increase in the number of gestational days versus earliest SPTB in the 17α-OHP group.
Keywords:  17 alpha-hydroxyprogesterone caproate; gestational age; intramuscular; intramuscular absorption; intramuscular injections; obstetric labor, premature; premature birth; pregnancy; preterm birth; preterm labor; progestogens; risk assessment; tocolytic agents; vaginal; vaginal absorption
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