Has your patient had a premature baby? Is she pregnant again? If so, you needto know that there is a new type of treatment that may help prevent anotherpreterm birth.

What Are the Potential Side Effects of 17P?

What Is 17P?

When Should the 17P Treatment Be Given?

Side effects are very rare. If side effects do occur, they commonly include soreness, swelling, itching, orbruising at the site of the injection.

The progesterone treatment known as 17 alpha-hydroxyprogesterone
caproate (17P) has been shown to reduce the risk of preterm birthamong women with a history of prior preterm birth. In 2003, two major
research studies found that the use of 17P resulted in a 33% reduction
in risk of recurring preterm birth.

Treatment should beinitiated between 160
and 216 weeks ofpregnancy and continued
every week until 366 weeks.

Additionally, although a woman may still deliver a few weeks early,
women who use 17P are more likely to carry the pregnancy at least
one week longer than are women who do not take 17P.

How Do I Give the 17P Treatment to My Patient?

Who Should Get 17P?
Women eligible for 17P must meet the following criteria:• Have a history of a previous singleton spontaneous preterm
birth between 200 and 366 weeks gestation.
• Have a current singleton pregnancy.
• Initiate treatment between 160 and 216 weeks gestation.
If an eligible woman presents to prenatal care late, 17P may
be initiated as late as 236 weeks.

16

1718

19

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21

Start between
16-20 weeks

22

23

24

25

26

27 28
WEEKS

2930

31

32

33

34

35

36 37 38 39 40
Best time
Stop atto give
37 weeksbirth

The majority of nurses give this injection in the gluteus muscle, alternatingsides each week. It may also be given in the anterior thigh. The shot isnot unusually painful. It has been compared to a Depo-Provera injection
with less medication but a thicker consistency. Patients can take Tylenol
and/or soak in a warm tub if they are sore, but this is usually not necessary. Many patients have been successful in finding a friend or family
member to give them the weekly injection once they have been trained.
Additional suggested instructions for administering 17P include:
1. Clean the vial top with an alcohol swab before use.
2. Clean the injection site with an alcohol swab before administration.
3. Draw up 1 ml of 17P in a 3cc syringe with an 18-gauge needle.
4. Change the needle to a 21-gauge 1½ inch needle before
injecting 17P.

Currently, studies have not demonstrated that 17P is aneffective intervention for the prevention of preterm birth in other pregnant women. The use of 17P is not
appropriate for women with a multi-fetal pregnancy, women with a short cervix and no prior preterm birth,or women with a previous medically indicated preterm birth.

The 17P medication is extremely thick. Careful technique is required to avoid overfilling the syringe andsubsequent wastage. Each weekly dose is 1 ml of 17P. The dose is the same for all eligible women.

Is It Safe?

What If My Patient Misses a Dose?
Studies show that 17P is safe and that there are no serious side
effects for the mother or the baby. Results also demonstrate that
there is no increase in the rate of birth defects for infants whose
mothers used 17P during pregnancy. One study continues to follow
infants into childhood and has observed no increased risk for birthdefects and other health problems.

Progesterone stays in the body for approximately 7 days. Therefore, it is important that a woman
receives a dose of 17P every week. The suggested range of time in between injections is 5 to 9 days
should it be necessary to plan around holidays or other delays.
If a week is missed, be sure that the patient receives the next dose. If a woman has difficulty making her
weekly appointments, consider teaching her or a family member how to give the shot. It is importantthat a patient receive the shots until 366 weeks in order to help carry her pregnancy as close to fullterm as possible. If the patient is experiencing signs and symptoms of preterm labor, continue to giveher 17P until she delivers or until 366 weeks of pregnancy.