Intramuscular 17α-hydroxyprogesterone caproate to decrease preterm delivery in women with placenta praevia: a randomised controlled trial.

We tested the hypothesis that 17 alpha-hydroxyprogesterone caproate (17 alpha-OHP-C) may decrease preterm delivery (PTD) in women with placenta praevia. This was a randomised controlled trial included 114 women with placenta praevia (between 24 and 28 weeks). They were randomly assigned to group I (17 alpha-OHP-C) who received weekly injection of 17 alpha-OHP-C (250 mg/IM) till completing 37 weeks' gestation or group II (Non 17 alpha-OHP-C). The percentage of placenta praevia patients went into PTD in the 17 alpha-OHP-C group was significantly less in comparison to the PTD in the Non 17 alpha-OHP-C group (similar to 37% vs. 63.5%, p = .004). Furthermore, the mean gestational age was significantly longer (36.7 +/- 0.7 vs. 34.9 +/- 1.2 weeks, p < .000), the mean number of bleeding attacks was significantly less and the mean birth weight was significantly higher (2841 +/- 159 vs. 2561 +/- 168 g, p < .000). In conclusion, maintenance tocolysis with intramuscular 17 alpha-OHP-C in placenta praevia women appears beneficial in decreasing the number of bleeding attacks, the percentage of PTD and the neonatal ICU admission.IMPACT STATEMENT What is already known on this subject? Over the last two decades, a large number of studies indicated that placenta praevia is a major risk factor for preterm labour and prematurity with its neonatal complications. Increasing caesarean section rates had proportionally increased the incidence of placenta praevia. What do the results of this study add? Up to now, the effective and safe tocolytic agent among these patients is not established. The results of this study (prospective, randomised and controlled with calculated sample size) added a considerable support for hydroxyprogesterone caproate as an effective, safe and cheap tocolytic agent with excellent patient compliance.