University of Wisconsin, Department of Family Medicine and Community Health, Madison.
Ebling Library, University of Wisconsin School of Medicine and Public Health, Madison.
J Fam Pract. 2022 Jan;71(1):E15-E17. doi: 10.12788/jfp.0334.
YES, we should stop the routine prescribing of IM progesterone to prevent preterm delivery. A 2003 randomized controlled trial (RCT) found that weekly intramuscular (IM) 17 hydroxyprogesterone (17-OHP) for women with a singleton pregnancy and a history of spontaneous preterm delivery decreased the preterm delivery rate by 34% (strength of recommendation [SOR]: B, single RCT). However, the follow-up 2020 PROLONG RCT did not find that 17-OHP prevents preterm birth or improves neonatal outcomes. This held true for subgroup analyses (SOR: B, single larger RCT). (Notably, though, the PROLONG study had very few Black participants when compared with the 2003 study.)The US Food and Drug Administration (FDA) has recommended withdrawing 17-OHP from the market. The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have released statements supporting shared decision-making with women regarding the prescribing of 17-OHP for preterm delivery prevention (SOR: C, expert opinion).
是的，我们应该停止常规开具肌内注射孕激素以预防早产。2003 年的一项随机对照试验（RCT）发现，对于有自发性早产史的单胎妊娠妇女，每周肌内注射 17-羟孕酮（17-OHP）可使早产率降低 34%（推荐强度[SOR]：B，单 RCT）。然而，2020 年的 PROLONG RCT 并没有发现 17-OHP 可以预防早产或改善新生儿结局。亚组分析也得出了同样的结论（SOR：B，单一大 RCT）。（值得注意的是，与 2003 年的研究相比，PROLONG 研究中的黑人参与者非常少。）美国食品和药物管理局（FDA）已建议将 17-OHP 从市场上撤出。美国妇产科医师学会（ACOG）和母胎医学学会（SMFM）发布了声明，支持与妇女共同决策是否开具 17-OHP 预防早产（SOR：C，专家意见）。
