17 a-HYDROXYPROGESTERONE CAPROATE- THE ANSWER TO PREMATURE LABOUR

Premature labour is said to be the most important obstetrical complication associated with perinatal morbidity and

mortality. Some studies have indicated that administration of a progestational agent can inhibit premature labour: In this

double-blind, randornised trial, the efficacy of such an agent was investigated.

It was found that premature delivery occurred significantly less often among high-risk patients given 17 a-hydroxypro­

gesterone caproate (17 aOHP-C) than among those given placebo. Although the results indicate that 17 aOHP-C is highly

effective in forestalling premature labour, it should be emphasised that the study group is small.

The subjects all had obstetric histories indicating an increased risk of premature delivery. They received weekly intra­

muscular injections of either 17 aOHP-C (250mg) or an equivalent volume of the sterile vehicle. Injections were given

from about the 16th week of gestation until the 37th week or until the patient delivered. Cervical suturing was performed

in 7 patients thought to have cervical incompetence.

• PrematureJabour (before 36 weeks gestation) occurred in none of 18 patients given 17 aOHP-C but in 41% of 22

patients given placebo. • The mean duration of pregnancy and mean birth weight were significantly greater for the group receiving 17 aOHP-C.

• Perinatal mortality was 0% for the group receiving the progestational agent and 27% for the placebo group.

Whether the results of the study are relevant to other groups of patients at risk of premature delivery remains to be

determined. The number of patients in the study was too small to demonstrate a reduction in morbidity associated with

prematurity, but this might be expected with more extensive use. Large-scale trials are needed to corroborate the efficacy

of_ this agent and to define the particular maternal and fetal risks. The risk of teratogenesis must be considered with any

drug given during pregnancy, this is especially applicable to hormonal medications. 17 aOHP-C is, however, normally

produced by the corpus luteum during pregnancy, and this argues against a teratogenic effect.

Johnson, J.W.C. et al.: New England Journal of Medicine 293: 675 (2 Oct 1975)

I NPHARMA 4th October, 1975 p.9