Recurrent Preterm Labor Prevention with 17 Alpha-Hydroxyprogesterone Caproate

Determination:

Molina Healthcare of New Mexico covers weekly injections of 17 alpha-hydroxyprogesterone caproate (17P) for patients with a history of preterm delivery (<37 weeks). Optimally, 250 mg injections should begin at 16 weeks either in the physicians office or via home nurse visits without interruption until delivery or 36 weeks of gestation.

Background:

The events that trigger preterm delivery are for the most part not known, but a history of spontaneous preterm delivery is one of the strongest risk factors for preterm birth in a subsequent delivery.

de Fonseca, et al. (2003) reported on the results of a randomized, placebo-controlled trial of progestin vaginal suppositories in high-risk women, and found that the incidence of preterm birth was significantly reduced, from 28.5% to 13.8% for births before 37 weeks, and from 18.6% to 2.8% for births before 34 weeks in the placebo versus the progesterone groups, respectively. More recently, Meis et al. (2003) reported the results of a multicenter randomized clinical study, showed that weekly injections of 17-alpha-hydroxyprogesterone resulted in a significant reduction in recurrent preterm labor and delivery for high risk women with a history of spontaneous preterm delivery.

Offering 17P as a benefit to pregnant women with a history of preterm delivery can reduce NICU days significantly and potentially decrease associated complications.

References:

da Fonseca EB, Bittar RE, Carvalho MH, Zugaib M. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: A randomized placebo-controlled double-blind study. Am J Obstet Gynecol. 2003; 188(2):419-424.

Meis PJ, Klebanoff M, Thom E, et al., and the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med. 2003;348(24):2379-2385.

Greene MF. Progesterone and preterm delivery-d�j� vu all over again. N Engl J Med. 2003;348(24):2453-2455.

Mason MV, House KM, et al. 17 Alpha-Hydroxyprogesterone Caproate (17P) Usage in a Medicaid Managed Care Plan and Reduction in Neonatal Intensive Care Unit Days. Managed Care. Oct 2005:58-63.

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