Abstract:

Preterm is one of the main causes of premature birth, neonatal morbidity and mortality. Spontaneous premature birth history is a known risk factor for recurring premature birth. Although some studies found that 17-alpha-hydroxyprogesterone caproate (17P) reduced recurrent premature birth by 34%, many women who did not benefit from its use did not apply this initiative. The trend in 2017 regarding premature birth rates in Fresno County in California and the new year 2020 data (10.1% and 9.8% respectively) are significantly higher compared to the state’s data of 8.6% and 8.8% respectively recorded for the same years. Therefore, in Fresno County, we aimed to explore the rates and purposes of 17P’s low use. In order to help identify the obstacles to the use of the 17P method, we retrospectively examined the diagrams of native patients at the Community Regional Medical Center in Fresno between January and December 2016 and conducted surveys of service providers and patients involved. After checking the age, body mass index, pregnancy interval and race/ethnic background, we found that women with private insurance received 3 times more 17P than those with state insurance (corrected probability rate 2.97, 95% GA: 1.6-6.51, p<.001). In addition, we found that only 23.3 percent of patients who suffered from 17P applied this initiative. Surveys have shown that the difficulty of completing the insurance approval process and receiving treatment within the clinically recommended period is the main obstacles to the use of 17P. Our study has confirmed that the 17P initiative has been misused to prevent recurrent premature birth and that this situation has disproportionately affected the patients with lack of prenatal care and state insurance.

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