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Twin Gestations Remain Associated with Risk for Preterm Delivery

Progesterone did not reduce the rate of preterm birth in women carrying twins.

Weekly treatment with 17 alpha-hydroxyprogesterone caproate (17P) recently was shown to reduce the rate of recurrent preterm birth in singleton gestations. Now, investigators have evaluated the effect of 17P on preterm birth in women with twin gestations. Women carrying twins were randomly assigned to receive weekly intramuscular injections of 17P (250 mg) or placebo beginning at 16 to 20 weeks’ gestation and continuing through week 34 or until delivery, whichever came first. The women received usual care and were evaluated at each weekly visit for side effects; the primary outcome was delivery or fetal death before 35 completed weeks’ gestation.

Delivery or fetal death before 35 weeks occurred in 41.5% of 325 women treated with 17P and in 37.3% of 330 women given placebo (relative risk, 1.1; 95% confidence interval, 0.9–1.3). Side effects in both groups were mild and were limited to the injection site. The authors concluded that 17P had no effect on the rate of preterm delivery in twin gestations.

Comment: Women who are pregnant with twins should not receive 17P: Despite the low risk for side effects, its efficacy is not greater than that of placebo. Moreover, administration of 17P could provide false reassurance to patients, who might in turn engage in activities that could increase the risk for preterm delivery.

— Sandra Ann Carson, MD

Published in Journal Watch Women's Health August 1, 2007

Citation(s):

Rouse DJ et al. A trial of 17 alpha-hydroxyprogesterone caproate to prevent prematurity in twins. N Engl J Med 2007 Aug 2; 357:454-61.

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