Of the 4 million babies born in the U.S. each year, approximately 12.3 percent of them will be premature and 3.56 percent will occur before 34 weeks. Premature birth is one of the leading causes of severe handicaps and has an annual cost of approximately $26 billion dollars. Although risk factors for preterm labor have been identified, there is still no cure. As stated in a previous blog post, when the cervix becomes weak (a condition called cervical insufficiency), the patient is at risk for second trimester miscarriages and preterm labor. Also, if a patient has a previous history of premature birth then she needs her cervix measured in a future pregnancy. If her cervix is short and measures between 16 mm and 25 mm before 23 weeks, she is at risk for premature labor and delivery. The recommended treatment for a short cervix is either progesterone suppositories or injections. A few months ago, there was profound controversy over an FDA approved injection that would cost approximately $1500.00 if purchased by the manufacturer, K-V Pharmaceuticals. Bending under political pressure, K-V reduced their price to $690.00.
The more options that are available for treatment of premature labor, the greater the chances are of achieving a full term baby. In the past two months, a new study has emerged which describes a progesterone gel that reduced birth rates before 33 weeks by 45 percent and improved newborn outcomes. This is a significant result. The earlier a preterm birth occurs, the greater the risk of having a baby who will subsequently have brain damage or physical handicaps. Therefore, the progesterone gel has great potential regarding reducing obstetrical complications. It will also provide patients with an option other than reliance on the progesterone injection. What are the differences between the progesterone injection and the gel? The injection is given once a week in the muscle but the gel has to be used daily. An injection has to be given, but the gel can be self-administered. The treatment should ideally begin at 16 weeks but no later than 21 weeks and must be continued until 37 weeks or delivery.
Any pregnant patient with a history of preterm labor should have seek early prenatal care and have their cervix measured via an ultrasound. If it is 25 mm or less, then the use of the progesterone gel might be a viable option in the near future.
Remember, a healthy pregnancy doesn’t just happen; it takes a smart mother who knows what to do.
*This blog post was originally published at Dr. Linda Burke-Galloway*