{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:41:33Z","timestamp":1790023293503,"version":"4.0.1"},"reference-count":51,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,11,18]],"date-time":"2018-11-18T00:00:00Z","timestamp":1542499200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The purpose of this study was to evaluate whether there are additional benefits of 17\u2010hydroxyprogesterone caproate (17\u2010<jats:styled-content style=\"fixed-case\">OHPC<\/jats:styled-content>) supplementation in preventing recurrent spontaneous preterm birth in women with a prophylactic cerclage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE, Scielo and the Cochrane Central Register of Controlled Trials) were searched for studies published before June 2018. Keywords included \u201cpreterm birth\u201d, \u201cprophylactic cerclage\u201d, \u201chistory\u2010indicated cerclage\u201d, \u201cpregnancy\u201d and \u201c17\u2010hydroxyprogesterone caproate\u201d. Studies comparing history\u2010indicated cerclage alone with cerclage+17\u2010<jats:styled-content style=\"fixed-case\">OHPC<\/jats:styled-content> were included. The primary outcome measure was preterm birth at &lt;24\u00a0weeks of gestation. Secondary outcome measures include preterm birth at &lt;28\u00a0weeks, &lt;32\u00a0weeks and &lt;37\u00a0weeks of gestation, respiratory distress syndrome, necrotizing enterocolitis, fetal birthweight, neonatal intensive care unit stay, mean gestational age at delivery, fetal\/neonatal death, neurological morbidity (intraventricular hemorrhage plus periventricular leukomalacia), neonatal sepsis and a composite of severe neonatal morbidity. Severe neonatal morbidity was defined as a composite measure of periventricular leukomalacia, intraventricular hemorrhage (grades III and IV), necrotizing enterocolitis or respiratory distress syndrome. Meta\u2010analysis was performed using the random\u2010effects model of DerSimonian and Laird. Risk of bias and quality assessment were performed using the ROBINS\u2010I and GRADE tools, respectively. PROSPERO Registration Number: CRD42018094559.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five studies met the inclusion criteria and were included in the final analysis. Of the 546 women, 357 (75%) received history\u2010indicated cerclage alone and 189 (35%) received adjuvant 17\u2010OHPC. The composite endpoint, severe neonatal morbidity, was present in 84 of 1515 neonates. Though there was a trend toward a reduced risk of preterm birth, the summary estimate of effect was not statistically significant when comparing cerclage alone with cerclage+17\u2010OHPC at &lt;24\u00a0weeks (relative risk [RR] .86, 95% confidence interval [CI] .45\u20101.65). Similarly, we found no differences in preterm birth at &lt;37\u00a0weeks (RR .90, 95% CI .70\u20101.17) and &lt;28\u00a0weeks (RR .85, 95% CI .54\u20101.32) when comparing cerclage alone with cerclage+17\u2010OHPC. There were no differences in fetal birthweight, respiratory distress syndrome or necrotizing enterocolitis comparing cerclage alone with cerclage+17\u2010OHPC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Intramuscular 17\u2010OHPC in combination with prophylactic cerclage in women with prior preterm birth had no synergistic effect in reducing spontaneous recurrent preterm birth or improving perinatal outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13488","type":"journal-article","created":{"date-parts":[[2018,10,19]],"date-time":"2018-10-19T13:34:50Z","timestamp":1539956090000},"page":"139-153","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Adjuvant 17\u2010hydroxyprogesterone caproate in women with history\u2010indicated cerclage: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0070-9840","authenticated-orcid":false,"given":"Ahizechukwu C.","family":"Eke","sequence":"first","affiliation":[{"name":"Division of Maternal Fetal Medicine &amp; Clinical Pharmacology Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine Baltimore MD, USA"},{"name":"Graduate Training Program in Clinical Investigation (GTPCI) Johns Hopkins University School of Public Health Baltimore MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanne","family":"Sheffield","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine &amp; Clinical Pharmacology Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine Baltimore MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest M.","family":"Graham","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine &amp; Clinical Pharmacology Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine Baltimore MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,11,18]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000930"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1984.tb04841.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1984.tb04840.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(15)30764-7"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.3964"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1247601"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1998.12050323.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001681"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1332799"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2017-0074"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.2217\/WHE.11.78"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.2217\/17455057.2.6.819"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000160432.95395.8f"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000174582.79364.a7"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa035140"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.03.010"},{"key":"e_1_2_9_18_1","volume-title":"Progesterone Therapy as a Technique to Reduce Preterm Birth in High\u2010Risk Pregnancies","author":"Blue Cross Blue Shield Association of Massachusetts","year":"2013"},{"key":"e_1_2_9_19_1","volume-title":"Progesterone Therapy in High Risk Pregnancies","author":"Blue Cross Blue Shield Association of North Carolina","year":"2017"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2017.1280019"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i157"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.328.7454.1490"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_9_25_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0","author":"Higgins JPT","year":"2011"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/0163278708324438"},{"key":"e_1_2_9_27_1","volume-title":"RevMan. 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