17-Alpha-Hydroxyprogesterone vs. Placebo for Preventing of Recurrent Preterm Birth: A Systematic Review and Meta-Analysis of Randomized Trials.

Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality. To estimate the effect of 17-alpha-hydroxyprogesterone caproate (17-OHPC) compared to placebo in singleton gestations for reducing the risk of recurrent PTB and neonatal morbidity and mortality. Systematic review and meta-analysis. Searching MEDLINE, Embase, Web of Science, SCOPUS, Cochrane Library, and clinical trial registries. Randomized controlled trials of singleton gestations with a history of PTB and treated with a weekly intramuscular injection of 17-OHPC or placebo. A random meta-analysis model was performed for the PTB outcomes (<32, <35, and <37 weeks) and neonatal outcomes (neonatal death, grade 3 or 4 intraventricular hemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, and sepsis). Effect estimates were measured by relative risk ratio (RR) with a 95% confidence interval (CI). Six works were included. There were no statistically significant reductions in the PTB risk following the use of 17-OHPC at <32 weeks (RR = 0.61, 95% CI: 0.13-2.77, and = 39%), <35weeks (RR = 0.60, 95% CI: 0.10-3.67, and = 51%), and <37 weeks (RR = 0.68, 95% CI: 0.46-1, and = 75%). Furthermore, all the neonatal outcomes were statistically similar between the two groups. Treatment with 17-OHPC is not associated with reducing the risk of PTB or neonatal outcomes compared to placebo.