• Rosa Fernandez-Macias, Raigam J Martinez-Portilla, Lucas Cerrillos, Francesc Figueras, and Montse Palacio.
• Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Catalonia, Spain.
• Int J Gynaecol Obstet. 2019 Nov 1; 147 (2): 156-164.

BackgroundPreterm birth causes an increased risk for perinatal morbidity and mortality.ObjectiveTo determine whether mid-trimester 17-alpha-hydroxyprogesterone caproate (17-OHPC) reduces the risk of recurrent preterm birth and adverse perinatal outcomes.Search StrategySystematic search to identify relevant studies published in different languages, registered after 2000, using appropriate MeSH terms.Selection CriteriaInclusion criteria were women between 16 and 26+6  weeks of pregnancy with history of preterm delivery in any pregnancy randomized to either 17-OHPC or placebo/no treatment.Data Collection And AnalysisThe number of preterm births and adverse outcomes in the 17-OHPC and placebo arms over the total number of patients in each randomized group were used to calculate the risk ratio (RR) by random-effects models using the Mantel-Haenszel method. Between-study heterogeneity was assessed using tau2 , χ2 (Cochrane Q), and I2 statistics.Main ResultsFour studies were included. There was a 29% (RR 0.71; 95% CI, 0.53-0.96; P=0.001), 26% (RR 0.74; 95% CI, 0.58-0.96; P=0.021), and 40% (RR 0.60; 95% CI, 0.42-0.85; P=0.004) reduction in recurrent preterm birth at <37, <35, and <32 weeks, respectively, in the 17-OHPC group compared with placebo. The reduction in neonatal death was 68% (RR 0.32; 95% CI, 0.15-0.66; P=0.002).Conclusions17-OHPC could reduce the risk of recurrent preterm birth at <37, <35, and <28 weeks and neonatal death.ProsperoCDR42017082190.© 2019 International Federation of Gynecology and Obstetrics.

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