Utilization of progesterone and cervical length screening for prevention of recurrent preterm birth

作者：Boelig, Rupsa C.^*; Jiang, Eva; Scheidemantle, Brooke; Villani, Michela; Berghella, Vincenzo

来源：Journal of Maternal-Fetal and Neonatal Medicine, 2019, 32(24): 4146-4153.

DOI：10.1080/14767058.2018.1481035

• Preterm birth
• prevention
• cervical length
• progesterone
• healthcare utilization

Objective: To assess utilization of progesterone and cervical length (CL) screening among women with prior spontaneous preterm birth (sPTB). Methods: This is a retrospective cohort study of women with prior sPTB. Primary outcomes were the use of progesterone and CL screening. Secondary outcomes were reasons for failure to utilize interventions and factors associated with use of recommended interventions. Results: 180 women had a prior sPTB. Of 171 women eligible for progesterone, 125 (74%) utilized it. Women who utilized progesterone were more likely to have a prior sPTB <28 weeks (50% vs 26%, OR 2.54 (1.18-5.42) p = .006) and a higher number of prior sPTB (1.5 +/- 0.9 vs 1.2 +/- 0.5, p = .02), and less likely to have a prior full term delivery (54% vs 72%, OR 0.47 (0.22-0.99), p = .04). Of 176 women eligible for CL screening, 157 (89%) utilized it. Women who utilized CL screening were less likely to have a prior full term delivery (59% vs 84%, OR 0.27 (0.07-0.95, p = .01)). The most frequent reason for lack of progesterone and CL screening was patient declining. Conclusion: Most women with prior sPTB received progesterone and CL screening. Those at highest risk for PTB based on obstetric history are more likely to utilize recommended interventions.