Is 17-Hydroxyprogesterone Caproate (17P) Safe for the Baby During Use in Preterm Birth Prevention?
Monday, January 14, 2008
Kenneth F. Trofatter, Jr., MD, PhD
•At Wed Jan 02, 10:11:00 AM 2008, Anonymous said…
Hello- I'm currently 15 weeks pregnant with my 3rd child. I have six year old twins that were born at 34 weeks (I originally went into PTL at 29 weeks). With a few rounds of Mag Sulfate and bedrest and drugs at home I was able to hold off until 34 weeks for delivery. My OB is suggesting Delalutin at 16 weeks in an effort to avoid the possibility of preterm labor with the pregnancy. I'm concerned because there are so many horror stories on the web about limb deformitites and stillborn babies from delalutin. Most seem to be from the 70's - has the product changed much since then? Wouldn't it make sense to assume my previous pre-term issues were related to a twin pregnancy?
Thanks
•At Wed Jan 09, 10:38:00 AM 2008, Anonymous said…
I too am in a similar situation. I gave birth to my son at 29 weeks due to a severe infection. My doctor also wants to put me on Delalutin injections starting at 17 weeks with my current pregnancy. I have researched this injection and found similar results to yours in terms of limb and genital defects as well as still births. I am extremely concerned and wondered in this medication has improved at all from the 70's as well. Any information would be greatly appreciated!
The use of 17P to help prevent early miscarriage and preterm birth dates back to the time before I started my residency in OB/GYN. In fact my first three children were 17P babies after my wife had had three consecutive miscarriages. Although there were no good controlled clinical trials, the teaching was that “It worked,” the side-effects for the mother were minimal (mostly injection site discomfort), and there did not appear to be the same level of risk for birth defects that was seen with DES. We went for a long period of time, however, when 17P was dropped from our regular armamentarium as we tried certain other drugs to help interrupt and delay preterm labor and birth. Unfortunately, none of these drugs have been very effective, almost all have unsatisfactory side-effects (and, in some situations, may be dangerous), and despite all efforts, the preterm birth rate has only continued to increase in the U.S. as we have addressed in this forum on previous occasions.
Although it is very difficult to predict who will have preterm labor and delivery, certain risk factors are associated with it and one of the most reliable is a prior history of preterm birth. Indeed, the earlier in gestation a prior preterm birth occurred, the greater the likelihood a woman will deliver prematurely again. And, if she has two or more preterm births, her risk can approach 50% that the next baby will be delivered early.
It was with cautious optimism then that we welcomed, a large, multicenter, randomized, double-blinded, placebo-controlled trial that showed weekly injections with 17P reduced by about one-third the risk of preterm delivery in women who had previously had a preterm birth (Meis, et al., N Engl J Med 2003;348:2379-85). That optimism grew when secondary analysis of the data revealed that 17P had its most beneficial effects on reduction of deliveries less than 34 weeks which incur the greatest risks for short- and long-term morbidity and mortality and excessive cost of medical care (Spong, et al., Am J Obstet Gynecol 2005;193:1127-31). In this later analysis, however, some concerns were also raised that there appeared to be a slightly higher fetal loss rate in the women who had received the 17P, but at this time, it cannot be concluded that this was the result of the drug itself or of other factors related to this high risk population of women. Early miscarriage rates and birth defects could not be commented upon in this study because the 17P was not begun until the patients were at least 16 weeks pregnant – well past the time of organogenesis and the usual time of miscarriage.
Anyway, returning to our readers’ comments, my first answer is no, the medication has not changed at all from the time it was introduced years ago. In fact, if anything, since the drug is now ‘formulated’ at compounding pharmacies across the nation, and is not under the scrutiny of BIG PHARMA (the product is no longer made by a pharmaceutical company – just wasn’t worth holding onto over the years), it’s composition is even less rigorously controlled, although the formulation is probably too simple to mess up in any way that would deleteriously affect either its safety or efficacy.
With regard to the issue of birth defects, especially the concerns related to limb and genital defects, let me first state that should probably not be a major worry at this point. As stated above, the currently recommended use of the drug involves starting it well beyond the development of the baby’s arms, legs, heart, genitalia, etc. All of that is basically completed by 12 weeks, and most even earlier. It is true that continued growth of all organs proceeds throughout the pregnancy and neurologic development, in particular, well beyond first trimester is especially important to the baby’s outcome, but to date, no data would suggest a major problem related to this. Of course, it will take many years to sort out whether or not subtle effects on the brain and neurologic or behavioral abnormalities are associated with the use of 17P.
To support these points, let me cite a few references. In 1982, Varma and Morsman evaluated the use of hydroxyprogesterone hexanoate (very similar to 17P) in early pregnancy for its adverse effects on fetal development (Int J Gynaecol Obstet 1982;20:13-17). One hundred and fifty women were begun on this drug by intramuscular injection at 6-8 weeks gestation and continued on therapy until 16-18 weeks. The control group consisted of 150 women with similar problems, primarily, recurrent miscarriages, who received no hormonal therapy. No significant differences related to adverse fetal/neonatal outcome or development were noted between the two groups.
The teratogenic effects of 17P have been evaluated in several animal studies. Seegmiller and colleagues (Teratology 1983;28:201-8) treated mice with doses of 17P ranging between 10 and 200 times the human therapeutic dose. At the highest doses (100 and 200 times the human doses), they found higher risks of maternal deaths (8% and 13%, respectively); and, all doses resulted in a slight increase in embryonic resorption (4-12% above controls). However, in surviving animals and their offspring, there were no significant affects on intrauterine growth, sex ratio, or malformation rates and it was specifically noted that the drug did not increase rate of masculinization, nor did it alter the development of nonreproductive organs.
In a later study, also done in mice, doses of 17P equivalent to 0.7, 7.0, and 70.0 times the dose in humans were administered between gestational days 7 through 19 – roughly equivalent to the period of most significant embryologic development in humans (Carbone and Brent, Am J Obstet Gynecol 1993;169:1292-8). In this study, no differences in fetal weight, resorptions, fetal deaths, number of male fetuses, or malformations were noted between the treated and untreated animals. Again, because of anecdotal concerns raised many years earlier, they specifically noted that there were no no increases in genital or nongenital birth defects, and no increase in limb deformities or bone calcification in the group treated with the 17P.
Hendrickx and colleagues (Teratology 1987;35:129-36) studied the effects of 17P given alone or with an estrogen (estradiol valerate) in rhesus and cynomolgous monkeys at weekly intervals between 20 and 140 days gestation. Although a higher rate of embryologic deaths were noted in the Rhesus monkeys (but not in the cynomolgous monkeys) at doses equivalent to (1X) and 10 times the human dose, no significant malformations or developmental abnormalities were identified. Not to belabor the work done to date in animal models, I would simply refer you to a recent review article on the subject by Christian and colleagues (J Matern Fetal Neonatal Med 2007;20:89-112). In this comprehensive review, the authors conclude that 3 studies point to a higher risk of embryo-fetal toxicity, including the ones cited above, but no consistent or significant teratogenic effect has been confirmed with the use of 17P.
Bringing this home, perhaps more reassuring is another recent study (Northen, et al., Obstet Gynecol 2007;110:865-72) that did follow-up evaluations of the babies born in the original 2003 17P trial of Meis and colleagues. At a mean age of follow-up in 194 children exposed to 17P and 84 placebo controls, “no significant differences were seen in health status or physical examination , including genital anomalies” between the 17P and the placebo children. Testing scores for “gender-specific roles” were also normal and comparable between the two groups. Since this is the only randomized, controlled study of substance published to date, it must be considered the most reliable information available as well and it would appear that 17P, as used in this trial, beginning at 16-18 weeks gestation, has a minimal risk for the fetus and newborn, at least from the standpoints of birth defects and development.
So, the final question...would I use 17P on my own kids again? Yeah, they all did turn out a little on the strange side, but look at who's their Daddy!
Labels: 17-hydroxyprogesterone caproate, 17P, delalutin., preterm delivery
30 Comments:
At Tue Jan 15, 04:58:00 PM 2008,
--c. said…
hi dr t --
i wrote in earlier after delivering my second stillborn daughter -- both after pprom. (to refresh your memory, my name is carole, i have a slightly elevated titer of anticardiolipin, and also typically take prometrium in my first trimester due to low measurements & three 1st trimester miscarragies.) i am now pregnant again (about 5 1/2 weeks) and have been prescribed a version of your empiric treatment: 4 mg folic, prenatal, heparin & baby aspirin, plus extra vitamins e & c, plus the daily prometrium. i am also going to see a perinatologist starting week 12 for biweekly cervical scans, although in both pprom events i had neither an infection nor, as far as anybody could tell, an incompetent cervix. (i have carried one baby to term with a normal labor that ended in a c-section.)
i am going to be put on 17P starting in my second trimester. my two docs agree that preterm labor has not been my problem, but they are also of the opinion(s) that the 17P can't hurt the pregnancy. would you consider this a normal or reasonable approach?
At Tue Jan 15, 06:46:00 PM 2008,
Anonymous said…
Thank you Dr.Trofatter for your informative response regarding P17 risks and preterm labor! I had mentioned in my original question that I went into labor at 29 weeks due to a Group B Strep infection. In your response you had stated that you weren't sure that I was a canidate for P17. Is this due to the circumstance of infection? Also, am I prone to infection due to having a previous one? Thank you in advance for your help as it is difficult to find information regarding this topic.
Sincerely,
Kerri
At Wed Jan 16, 06:57:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Carole: Hello again! I like the idea about going to see the MFM folks. It will be interesting to see what your cervix does over time. I doubt the 17P will "hurt" but a lot depends on the cause of the PPROM. See why I am sometimes converned under these circumstnaces in my response to the reader right after you. Good luck with your pregnancy and please let me know how things turn out! Dr T
At Wed Jan 16, 07:04:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Jan 15: Yes, ny concern is the possibility of the 117P 'hiding' an infection. I don't thinnk it necessarily places you at greater risk for getting an infection, but it could suppress your body's response so that the infection gets further along then in normally would before we realize you have it. If you have read any of my posts on GBS, it can be a sneaky bug! Many women are chronic carriers of GBS and some seem to have a suboptimal immune response to it and are, therefore, at risk for recurrent complications related to the bacterium. Many women with PPROM or with an 'unexplained' fetal demise may have had 'subclinical' infections that damaged the baby without causing overt evidence of an infection in the Mom. That's why I would be a little hesitant to prescribe it to you, but that's just my personal opinion! Thanks again for reading. Dr T
At Thu Jan 17, 07:13:00 AM 2008,
--c. said…
THANK YOU for the heads up about the infection. a subclinical infection would make so much sense. my ob this time is going to do bv cultures regularly, but i'll ask about 17P and other infections and be on the lookout for that, as well.
it's so hard not to have an answer for recurrent pprom, but it is very relieving to know there are things we can look for that we didn't look for before. thank you!
At Thu Jan 17, 11:47:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To -c Jan 17: You're welcome and GOOD LUCK! Dr T
At Thu Jan 17, 06:54:00 PM 2008,
Anonymous said…
Hi I was hoping you could give me some insight. I am 34 y/o soon to be 35 and have two healthy boys, 7 and 5. I would like to have another baby. I had two miscarriages last year, one at 10 weeks and another at 6 weeks. I am pregnant for the third time and have an HCG of 20 at 5 weeks and the doctor wants me to wait a week and have the HCG test repeated. she checked my progesterone levels (on the second pregnancy they were very low, but they said it looked okay this time) I have been off birth control for a year and can tell that my endometriosis is coming back because of increased cramping, I have HTN, and have been experiencing what they think may be PMDS. What is my next step if I do lose this third pregnancy in a row. I feel lost, upset, and wonder if there is something else that could be wrong...Please help!
JM
At Mon Jan 21, 04:44:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Jan 17: I do not have a simple answer for you. That hCG is VERY low for a 5 week pregnancy, so that is not a good sign at this point. he REI docs with whom I work believe that endometriosis is a significant cause of recurrent early pregnancy loss for reasons we do not fully understand. If you have endometriosis, they would probably suggest Lupron suppression for 6 months and then ovulation induction with Letrazole and hCG. Also if you are hypertensive at your age, I would recommend a weight reduction program (if you are overweight) and give some thought to metformin therapy for several months prior to conception as well. What sort of workup have you had to date from the immunologic, thrombophilia, and hormonal standpoints? I am curious to know. Thanks for reading and please get back to me! Dr T
At Wed Jan 23, 07:05:00 PM 2008,
Anonymous said…
Dear Dr. T,
Thank you for your response. I have gotten better news since I wrote you on 1/17/08. My HCG increased from 20 to 1360 in one week. My doctor ordered another HCG that I had taken today and my levels are now over 3000. I am scheduled for an ultrasound in the morning because I have been cramping when I am on my feet alot or with exertion. There is no spotting, but she is trying to role out a tubal because of my history. The only work up that I have had is for my thytoid and progesterone. According to the charts my thyroid is wnl,but there is a family history of problems. With my second miscarriage my progesterone was low. When she tested me this time around 1/14/08 she said my levels looked ok, but they did not tell me what they were (that was when my HCG was 20). I know that they were not very optomistic at that time. I had another test taken today and have to wait 2-3 days for the results. I should be 6 weeks according to my last menstrual cycle on 12/13/07. I am 5'5 and weigh 140 pounds. I have had HTN since I was 32. I think I forgot to mention that every pap test comes back that I have inflammation. My endometriosis was diagnosed before I had my first child. I am not familiar with the treatments or tests that you mentioned, but am willing to do research. I really appreciate your advice and direction. I am hoping that all is going to be ok this time... I guess I will know more tomorrow, but truth be told I am still nervous. Is there anything else I should be asking my doctor for? I have never had problems conceiving only progressing with the last two pregnancies.
Thanks again and I look forward to reading your next post.
At Thu Jan 24, 04:38:00 PM 2008,
Anonymous said…
Dear Dr. T,
Anonymous Jan 17 again. Update, they saw a gestational sac, but said too early to see baby. Progesterone levels dropped from 23 to 17 despite increasing HCG. Should I be worried?
Thanks for your help
At Fri Jan 25, 08:05:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Jan 23: Great on the hCGs. You probably just ovulated later than you thought. No other sugestions for the time being. At your current hCG level, they should be able to tell you if this preganncy is in the uterus by ultrasound. Hope things go well for you this time, and if they don't we can talk about those other things! Regards, Dr T
At Fri Jan 25, 11:23:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Jan 24: I am encouraged by the hCG rise, but discouraged by the progesterone fall. I hope it is not real, but if it is and you do lose this pregnancy,you might benefut from progesterone support (not 17P) staring in he luteal pahsea after ovulation and continuing through first trimester. Best wishes and luck! Dr T
At Mon Jan 28, 06:45:00 PM 2008,
Anonymous said…
Dear Dr. T,
Thank you so much for your response. It is helpful to get your opinion and advice. My doctor started me on progesterone suppositories 2 times daily after the decrease from 23 to 17 and my cramps decreased. I started them on 1/24/08, but began some spotting yesterday and today. I was devestated and called my doctor. She ordered another US for 2/1/08 with repeat HCG and Progesterone levels. I am guardedly hopeful. I will keep you posted. thank you!
At Wed Jan 30, 07:09:00 AM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Jan 26: Thanks for letting me know. We will be pulling for you...
Dr T
At Tue Feb 05, 07:13:00 PM 2008,
Anonymous said…
Dear Dr. T,
update from anonymous Jan 26. US shows heart beat, HCG over 33,000, and progesterone 20. We are keeping our fingers crossed.
Thanks for your site, your input, and support.
At Wed Feb 06, 05:18:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Feb 5: Great news! hang in there, girl! Let us know, okay? Dr T
At Thu Feb 07, 02:36:00 PM 2008,
Anonymous said…
Dear Dr. Troffater.
i have previously been pregnant 3 times and have delivered prematurely with all of them, 17 wks, 22 1/2 wks, and 7 1/2 wks. i am currently pregnant for the fourth time, 16 wks. this sat. my doctors suggest that i have weekly injections of 17 Hydroxy progesterone to prevent preterm labor of this pregnancy. however they are uncertain as to whether the cause is preterm labor or incompetent cervix. i was told that this drug is only beneficial for the prevention of preterm labor. i am very skeptical when it comes to relying on drugs of any sort, and am not sure as whether i should go through with this treatment or not, only to regret it later. i have researched this and have not found enough info. assuring me of it's safety. i am currently on bed rest. can strict bed rest keep me from delivering prematurely again, or will i need to have the injections administered? are there any alternatives to this?
At Thu Feb 07, 02:51:00 PM 2008,
Anonymous said…
Dear Dr. T-
in your opinion, which is more beneficial, a cerclage or 17 Hydroxy progesterone injections? i was recently told that after administration, if the injections do not work, i may need the cerclage. what factors make me a candidate of either of these and determine their effectiveness? what are the risks/ side effects, long term/ short term?
At Fri Feb 08, 05:46:00 PM 2008,
Anonymous said…
Dear Dr. Trofatter:
If I take 17Hp for one pregnancy, would I be required to take it for all future pregnancies, or will I be given the option?
At Thu Feb 14, 06:58:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Feb 7: Your questions are straightforward and excellent and the answer is not so simple. At some point I will have to devote another whole post to cerclage. The answer depends on what your doctors think they might be treating and quite frankly, that depends, somehwat, on a detailed review of the previous pregnancy complications that you have not told me about and that have led you to this point. If you truly have an 'incompetent cervix', personally, I am a cerclage person. Placed early in pregnancy (13-14 weeks), a cerclage carries very low risks and is highly effective if the person who has placed it really does it right. Unfortunately, many cerclages are NOT well-placed and their efficacy has come into question more for this reason than anything else. Your doctors probably have not been able to determine (based presumably on your past OB history) whether you had problems related to premature labor or whether you have an incompetent cervix. (It can be extremely difficult once the cervix has begun to change to decide which came first, the cervical change or the contractions). Under those circumstances, we will often follow you with cervical ultrasounds, consider using 17P if the history is strong enough, and then place a 'rescue cerclage' if and when the cervix starts to shorten (particularly if here is "funneling" of the membranes into the cervical canal), although this might not happen until 18-22 weeks (and sometimes even later). Of course, placing a cerclage at this point always carries more risk than if placed earlier in the pregnancy, but again, in experienced hands, it is often successful in prolonging pregnancy, especially if very early preterm birth appears imminent if something isn't done. The 17P appears to be relatively safe from midtrimester on, but I would suggest you read the blogs I have already posted on this subject. I wish you luck! Please let us know how things turn out.
At Thu Feb 14, 07:24:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Feb 7: Personally, with your history, I would have placed the cerclage at 13-14 weeks, still followed your cervix with serial ultrasound examinations, starting at about 16 weeks, and considered the 17P if you had any evidence of uterine activity. We have done a study with a vaginal progesterone compound (Prochieve) that seemed to be most effective in preventing early delivery in women with a short cervix. Since this is the same progesterone that your body and the placenta make, it should be completely safe for the baby. I do NOT trust bedrest alone for various reasons. And I certainly do not trust progesterone alone for a true incompetent cervix! Good luck and let us know how things turn out. Dr T
At Thu Feb 14, 07:29:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Feb 8: If the 17P has a beneficial effect in your case, that will not carry over to another pregnancy. It has no long-term benefits. If you take it for one pregnancy, didn't really need it, and did well, you'll probably do well the next time whether or not you take it! The question is, do you want to take the chance of not taking it if you really do benefit it! Wish the answers were simple, but they are not! Thanks for reading! Dr T
At Fri Feb 15, 11:38:00 AM 2008,
Anonymous said…
hi dr t -- it's carole again. i realize as i keep reading the comments and your answers that i don't know how or why 17P works. do we know? i'd love to know if it's (relatively) easy to explain.
At Sat Feb 16, 12:46:00 AM 2008,
Anonymous said…
Dear Dr. T:
Anonymous Feb. 07 again- Thank you for your informative response! To fill you in on my history, my first pregnancy, I went into labor at 17 wks.. I began having strong contractions at work, but did not realize what was happening at the time. There was no bleeding. Later that evening, I delivered the amniotic sac, still attached and full of fluid, but without the baby, who was still inside my uterus. The heartbeat began dropping rapidly, resulting in the death of my baby. My labor was induced by the doctor popping the sac. This is when I first found out that I was O-. My husband is O+. My second pregnancy, I went to the ER at 20 wks., due to vaginal bleeding after an uncomfortable, restless night. That's when they told me I was dilated 4cm with ruptured, bulging membranes. Since I have always had strong cramping during my menstrual cycles, I again, thought nothing of it. My uterus appeared to be tremoring instead of contracting. I was in the hospital for two weeks, before I delivered my baby who only lived for an hour. My third pregnancy, I miscarried at 7 1/2 wks.. Each time I was working, and on my feet constantly. I often wondered if the weight of the baby played a part in this.
That brings me to this current pregnancy. This past Tuesday I had an ultrasound done to check my cervical length. The result was a 4.6, which my doctor says is good. He said that anything below 3 is to be concerned about. He then ruled the cause out to preterm labor and not incompetent cervix. I decided to go ahead and take the 17Hp, which will be given weekly. Hopefully this will be beneficial for this pregnancy. I am trusting the Lord to bring me to full term this time! Once again, thank you for your response. I will be sure to keep you posted!
Sincerely,
Ana
At Fri Feb 22, 08:10:00 AM 2008,
Anonymous said…
Hi Doctor T-
I posted my original question to you on Jan. 15th regarding 17P injections. I told my doctor my (and your)concerns about it possibly hiding an infection and he agreed to do routine screening for Group B Strep. My question is do you feel this will be an effective preventative measure? Also, I am 23 weeks along and was "diagnosed" with a short cervix (2.93mm)does this automatically put me at a higher risk for preterm labor and if and when would you recommend a cerclage in my situation?? My doctor has put me on modified bed rest as well. Thanks for your input!! Kerri
At Fri Feb 22, 08:40:00 AM 2008,
Anonymous said…
Hi again! I just wanted to add to my last posting that I also have PCOS. I asked my doctor if there was any relation to my son being born at 29 weeks with this disorder and he assured me that they were unrelated. However, I just read one of your postings regarding a correlation between an incompetent cervix and PCOS. This was something that I had suspected from the beginning after meeting several mothers with PCOS in the NICU. Do you feel that my previous preterm labor could be a result of PCOS and will P17 help in my situation? Also, do the hormone changes associated with PCOS have anything to do with preterm labor? Thanks again, Kerri
At Fri May 09, 03:25:00 PM 2008,
Megan said…
I was told about the injections from a friend who had them in her last pregnancy. I have a short cervix, but what has not appeared to be IC. With my first healthy pregnancy (2 prior miscarriages in the first trimester) my cervix shortened from 35mm to 22mm between 19 and 28 weeks. It stayed around 22-23mm from 28 weeks on and I delivered just about at term. With my second pregnancy I was never checked due to insurance flaws, but stayed off my feet when I could and delivered my son almost at term by repeat c-section. I am currently 17w4d pregnant with my 3rd healthy pregnancy and just had a scan that showed my cervix to be at 26.8mm but firm and closed. I am going to be rechecked in 11 days from now, and was wondering if I should ask about the injections or if there is anything else I should be doing, or not doing. I have stopped all exercising and am doing as little as possible with a 2 and a 1 year old at home. Also, since I have had short cervix before (at least in 1 pregnancy) but never had PTL could I just have a shorter but still firm cervix? Thank you for any and all advice you can give.
Megan
At Tue May 20, 03:29:00 PM 2008,
Mom of 3 boys said…
I am 11 weeks pregnant with my 4th child and my Dr talked to me about putting me on these 17P shots because my last child ( he is now 2) was born at 36wks by c-section because I was in lbor. He said that I would start them at 16weeks and continue through 36 weeks. Is it something I should do and what side effects are there? My first child was born at 41wks after some preterm labor and bedrest, second was born at 39wks scheduled c-section and my third was born at 36weeks and weighed 7lbs and was completely healthy. Do you think that it is really nessacary to hve these shots?
At Sun May 25, 04:31:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
Mom of 3 boys said:
I am 11 weeks pregnant with my 4th child and my Dr talked to me about putting me on these 17P shots because my last child ( he is now 2) was born at 36wks by c-section because I was in lbor. He said that I would start them at 16weeks and continue through 36 weeks. Is it something I should do and what side effects are there? My first child was born at 41wks after some preterm labor and bedrest, second was born at 39wks scheduled c-section and my third was born at 36weeks and weighed 7lbs and was completely healthy. Do you think that it is really nessacary to hve these shots?
At Sun May 25, 04:34:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Mom of 3 BOYS: I am not going to try to second guess your doctor here, but you have minimal risk for very preterm delivery and, therefore, it is unlikely the 17P will be much benefit, unless you have a history of premature cervical "shortening" early in each of your pregnancies. One option would be to have you doctor evaluate your cervical length periodically and then consider the 17P if it should start to shorten. Good luck and thanks for reading! Please let us know how things turn out. Dr T
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