Understanding if, How, and Why Women with Prior Spontaneous Preterm Births are Treated with Progestogens: A National Survey of Obstetrician Practice Patterns

Abstract

Objective In 2017, the Society for Maternal-Fetal Medicine (SMFM) Guideline Committee reaffirmed that 17α-hydroxyprogesterone caproate (17-OHPC) to prevent preterm birth (PTB) is underutilized. We sought to determine what drove progestogen treatment choice of obstetricians managing pregnant women with histories of 1+ singleton spontaneous PTBs (< 37 weeks) who then delivered singleton gestations within the previous 12 months.

Subjects We recruited a nationally representative random sample of obstetricians to abstract medical records of study-qualified patients. Of the 423 study-qualified physicians contacted, 358 (85%) participated; 56 (16%) maternal fetal medicine specialists and 302 (84%) general obstetrician/gynecologists (OB/GYNs) extracted data from 991 eligible patient charts.

Results Almost three-fourths of patients (73.6%) were treated with 17-OHPC; 18.6% received vaginal progesterone, and 11.8% were not treated. Key drivers of physicians' choice to (1) prescribe branded 17-OHPC were “FDA (Food and Drug Administration) approval” (52% relative influence [RI]) and “SMFM guidelines” (24% RI); (2) prescribe vaginal progesterone were “ease of administration” (32% RI) and “shortened cervix” (16% RI); and (3) not provide prophylaxis were “patient not informed of risk” (35% RI) and “no shortened cervix” (29% RI).

Conclusion Study findings support SMFM's contention of continued 17-OHPC underutilization to prevent PTB. Need for additional physician education merits assessment along with appropriate follow-up actions.

Keywords

Spontaneous Preterm Birth (SPTB) - prematurity - 17α-hydroxyprogesterone caproate (17-OHPC) - progestogen - vaginal progesterone - maternal fetal medicine specialists (MFMs) - shortened cervix

Ethics Approval and Consent to Participate

This article is based on previously existing observational data (i.e., retrospective chart information). Our research did not involve interventional studies of human or animal subjects performed by any of the authors. This retrospective study used anonymized, deidentified data, and no personal, individually identifiable health information was collected. Data were reported in the aggregate. Formal consent was not required for this study which was classified as exempt under 45CFR46. 101(b) (4) by Solutions IRB (Little Rock, AR).

Availability of Data and Materials

The dataset generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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