17-alpha-hydroxyprogesterone caproate for the prevention of preterm birth in women with prior preterm birth and a short cervical length

Am J Obstet Gynecol. 2010 Apr;202(4):351.e1-6. doi: 10.1016/j.ajog.2010.02.019.


Objective: We sought to evaluate 17-alpha-hydroxyprogesterone caproate (17P) for prevention of preterm birth (PTB) in women with prior spontaneous PTB (SPTB) and cervical length (CL) <25 mm.

Study design: We conducted planned secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development-sponsored randomized trial evaluating cerclage for women with singleton gestations, prior SPTB (17-33 6/7 weeks), and CL <25 mm between 16-22 6/7 weeks. Women were stratified at randomization to intent to use or not use 17P. The effect of 17P was analyzed separately for cerclage and no-cerclage groups. Primary outcome was PTB <35 weeks.

Results: In 300 women, 17P had no effect on PTB <35 weeks in either cerclage (P = .64) or no-cerclage (P = .51) groups. Only PTB <24 weeks (odds ratio, 0.08) and perinatal death (odds ratio, 0.14) were significantly lower for those with 17P in the no-cerclage group.

Conclusion: 17P had no additional benefit for prevention of PTB in women who had prior SPTB and got ultrasound-indicated cerclage for CL <25 mm. In women who did not get cerclage, 17P reduced previable birth and perinatal mortality.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • 17 alpha-Hydroxyprogesterone Caproate
  • Adult
  • Cerclage, Cervical
  • Cervical Length Measurement*
  • Female
  • Fetal Death / prevention & control
  • Humans
  • Hydroxyprogesterones / therapeutic use*
  • Infant, Newborn
  • Logistic Models
  • Multivariate Analysis
  • Perinatal Mortality
  • Pregnancy
  • Premature Birth / mortality
  • Premature Birth / prevention & control*
  • Progestins / therapeutic use*
  • Treatment Outcome
  • Uterine Cervical Incompetence / drug therapy*
  • Uterine Cervical Incompetence / surgery
  • Young Adult


  • Hydroxyprogesterones
  • Progestins
  • 17 alpha-Hydroxyprogesterone Caproate