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 - 17
α -hydroxyprogesterone caproate (17-OHPC) - progestogen - vaginal progesterone - maternal
fetal medicine specialists (MFMs) - shortened cervix
