Obstet Gynecol Sci.  2021 Nov;64(6):484-495. 10.5468/ogs.21264.

17-alpha hydroxyprogesterone caproate for the prevention of recurrent preterm birth among singleton pregnant women with a prior history of preterm birth: a systematic review and meta-analysis of six randomized controlled trials

Affiliations
  • 1Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
  • 2Department of Obstetrics and Gynecology, College of Medicine, King Saud University, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
  • 3Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, Saudi Arabia
  • 4Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
  • 5Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
  • 6Department of Neonatology, King Fahad Medical City, Riyadh, Saudi Arabia
  • 7Department of Obstetrics and Gynecology, King Saud Hospital, Unayzah, Qassim, Saudi Arabia
  • 8Department of Obstetrics and Gynecology, Faculty of Medicine at Rabigh, King Abdulaziz University, Rabigh, Saudi Arabia
  • 9Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
  • 10Department of Obstetrics and Gynecology, Alfaisal University, Riyadh, Saudi Arabia
  • 11College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA

Abstract

To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that investigated the clinical benefits of 17-alpha hydroxyprogesterone caproate (17OHPC) in the prevention of recurrent preterm birth (PTB) among singleton pregnant women with a previous history of PTB. We searched four major databases up till April 2021 and assessed the risk of bias in the included studies. We meta-analyzed various maternal-neonatal endpoints (n=18) and pooled them as mean difference or risk ratio (RR) with 95% confidence interval (CI) using the random-effects model. Six RCTs met the inclusion criteria, comprising 2,573 patients (17OHPC=1,617, control=956). RCTs revealed an overall low risk of bias. The rates of PTB <35 weeks (n=5 RCTs; RR, 0.77; 95% CI, 0.63-0.93; P=0.008), PTB <32 weeks (n=3 RCTs; RR, 0.68; 95% CI, 0.51-0.91; P=0.009), neonates with low birth weight (<2.5 kg) at delivery (n=3 RCTs; RR, 0.63; 95% CI, 0.5-0.79; P<0.001), and neonatal death (n=4 RCTs; RR, 0.41; 95% CI, 0.20-0.84; P=0.02) were significantly reduced in the 17OHPC group compared with the control group. Moreover, 17OHPC treatment correlated with a significantly decreased rate of retinopathy (n=2 RCTs; RR, 0.42; 95% CI, 0.18-0.97; P=0.004). However, there were no significant differences in the rates of neonatal intensive care unit admission, cesarean delivery, and other pretermrelated complications between both the groups. Among singleton pregnant women with a prior history of PTB, 17OHPC may favorably decrease the risks of recurrent PTB and reduce the rate of neonatal death.

Keyword

17-alpha hydroxyprogesterone caproate; Pregnancy; Preterm birth; Premature birth
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