(1022) Progesterone Use Following Previable Prelabor Rupture of Membranes

Many preterm intervention studies, including the Meis trial, do not include women with history of preterm birth (PTB) less than 20 weeks of gestation. Research looking at subsequent pregnancy outcomes in women with a history of previable PPROM is limited. We explored progesterone use in women with a history of previable preterm prelabor rupture of membranes (PPROM) between 16 and 23 weeks of gestation and the effect of progesterone use on reduction of preterm delivery in a subsequent pregnancy. 


Study Design:

We conducted a multi-center, retrospective study of women with previable PPROM between 16w0d and 22w6d of gestation occurring between 1/1/2010-12/31/2020. Exclusion criteria included cases of IUFD prior to PPROM, twins or multiples. The first subsequent pregnancy reaching the second trimester was then selected for review. Investigators searched the EMR for documentation of intramuscular (IM) and vaginal progesterone use in both the index and subsequent pregnancy. Pearson’s chi-squared test was used to determine the effect of progesterone use on PTB in subsequent pregnancies. 


Results:

133 patients had previable PPROM between 16w0d-22w6d of gestation, with 27.3% of women having documented progesterone use in this pregnancy (12.9% IM vs 14.4% vaginal, p = 0.10). 63 women had a subsequent pregnancy reaching the second trimester, with 69.8% using progesterone (65.9% IM vs 34.1% vaginal). Of the subsequent pregnancies using progesterone, 65.9% (52.5% IM vs 20.0% vaginal) delivered at a gestational age >37w compared to 34.1 (34.8% IM vs 30.4 vaginal) at ≤37w (p=0.54).


Conclusion:

The majority of patients with a history of previable PPROM used progesterone in some form in the following pregnancy. However, treatment with progesterone in the subsequent pregnancy (IM or vaginal) did not significantly change whether the patient delivered at term.