Journals / Perinatoloji Dergisi / 2021 / Cilt: 29 - Sayı: 2
Understanding barriers to utilization of 17-hydroxyprogesterone caproate and other interventions to prevent preterm birth in Fresno County, California
- Journal
- Perinatoloji Dergisi
- Pages
- 155–164
- DOI
- —
Abstract
morbidity and mortality. A history of prior spontaneous preterm birth is a known risk factor for recurrent preterm birth. While 17- alpha-hydroxyprogesterone caproate (17P) has been found in some studies to reduce recurrent preterm birth by 34%, many women who could have benefited from its use did not receive this intervention. We sought to investigate the rate of and reasons for underutilization of 17P in Fresno County, California, where the preterm birth rate trend from 2017 and recent 2020 data showed a significantly higher rate at 10.1% and 9.8% respectively, when compared to the state average of 8.6% and 8.8% respectively. Methods: We conducted a retrospective chart review of patients who delivered at Community Regional Medical Center in Fresno from January to December 2016, and surveys of providers and patients, to help identify barriers to 17P utilization. Results: After controlling for age, body mass index, interpregnancy interval, and race/ethnicity, we determined that women who had private insurance were 3 times more likely to have received 17P compared to women with public insurance (adjusted odds ratio 2.97, 95% CI: 1.6–6.51, p
Özet
Amaç: Preterm do¤um, neonatal morbidite ve mortalitenin önde gelen sebeplerinden biridir. Spontan preterm do¤um geçmifli, rekürran preterm do¤um için bilinen bir risk faktörüdür. Baz› çal›flmalarda 17- alfa-hidroksiprogesteron kaproat›n (17P) rekürran preterm do¤umu %34 azaltt›¤› bulunsa da, kullan›m›ndan faydalanamam›fl birçok kad›- na bu giriflim uygulanmam›flt›r. Kalifroniya’daki Fresno County’deki preterm do¤um oran› ile ilgili 2017 y›l›ndaki e¤ilimi ve yeni 2020 y›l› verileri (s›ras›yla %10.1 ve %9.8), eyaletin ayn› y›llar için kaydedilen s›- ras›yla %8.6 ve %8.8'lik verileri ile karfl›laflt›r›ld›¤›nda anlaml› bir flekilde daha yüksektir. Bu nedenle Fresno County'de, 17P’nin az kullan› m›n›n oranlar›n› ve amaçlar›n› araflt›rmay› amaçlad›k. Yöntem: 17P kullan›m›na yönelik engelleri tespit etmeye yard›mc› olmas› amac›yla 2016 Ocak – Aral›k aylar› aras›nda Fresno’daki Community Regional Medical Center’da do¤um yapan hastalar›n çizelgelerini retrospektif olarak inceledik ve hizmet sa¤lay›c›lar ile hastalar›n kat›ld›¤› anketler yapt›k. Bulgular: Yafl, vücut kitle indeksi, gebelikler aras› aral›k ve ›rk/ etnik köken yönünden kontrol ettikten sonra, özel sigortas› olan kad›nlar›n devlet sigortas› olanlara k›yasla 3 kat daha fazla 17P ald›klar›n› belirledik (düzeltilmifl olas›l›k oran› 2.97, %95 GA: 1.6–6.51, p