Division of Maternal-Fetal Medicine, Columbia University Medical Center, New York, NY 10032, USA.
Am J Obstet Gynecol. 2013 Sep;209(3):269.e1-7. doi: 10.1016/j.ajog.2013.05.027. Epub 2013 Jun 6.
The purpose of the study was to evaluate whether 17-alpha-hydroxyprogesterone caproate (17-OHPC) exposure is associated with the rate of cervical shortening.
Women with a history of spontaneous preterm delivery (PTD) at <37 weeks' gestation who had serial cervical length measurements (2009-2012) were identified. 17-OHPC administration and outcome data were collected. We excluded patients with multiple gestations, indicated PTDs, major fetal anomalies, cerclage, and vaginal progesterone use. The rate of cervical shortening was modeled in relation to 17-OHPC status with the use of methods for longitudinal data analysis.
Two hundred thirty-seven patients with 1171 cervical length measurements were included, of whom 184 patients (77.6%) were exposed to 17-OHPC. Gestational age, number of previous PTDs, gestational age at initiation, and interval between cervical length examinations were similar between the 2 groups, although women who were not exposed to 17-OHPC were more likely to have delivered multiples in their previous PTD (24.5% vs 4.4%; P < .01). In the entire cohort, the rate of cervical shortening was identical, regardless of 17-OHPC exposure (0.85 mm per week). Among term deliveries, the rates of cervical shortening per week, on average, were 0.9 and 0.8 mm per week among women with and without 17-OHPC, respectively (P = .76). Among preterm deliveries, the corresponding rates were 0.8 and 1.2 mm, respectively, among women with and without 17-OHPC (P = .67).
Cervical shortening among women with previous preterm delivery occurs at a similar rate, regardless of exposure to 17-OHPC.
本研究旨在评估 17-α-羟孕酮己酸酯（17-OHPC）暴露是否与宫颈缩短率有关。
本研究纳入了 2009 年至 2012 年间有自发性早产（PTD）史且接受过多次宫颈长度测量的患者。收集了 17-OHPC 给药和结局数据。我们排除了多胎妊娠、有指征的 PTD、胎儿严重畸形、宫颈环扎术和阴道使用孕激素的患者。采用纵向数据分析方法，研究了 17-OHPC 状态与宫颈缩短率的关系。
共纳入 237 例患者的 1171 次宫颈长度测量值，其中 184 例（77.6%）患者接受了 17-OHPC 治疗。两组患者的妊娠年龄、既往 PTD 次数、开始治疗时的妊娠周数和宫颈长度检查间隔相似，但未接受 17-OHPC 治疗的患者既往 PTD 中多胎妊娠的发生率更高（24.5% vs 4.4%；P <.01）。在整个队列中，无论是否接受 17-OHPC 治疗，宫颈缩短率均相同（每周 0.85mm）。在足月分娩中，每周宫颈缩短率平均分别为接受和未接受 17-OHPC 治疗的患者为 0.9 和 0.8mm/周（P =.76）。在早产分娩中，接受和未接受 17-OHPC 治疗的患者分别为 0.8 和 1.2mm/周（P =.67）。
既往有早产史的女性，无论是否暴露于 17-OHPC，其宫颈缩短率相似。
