Preterm birth is the leading cause of neonatal mortality in the United States and contributes significantly to short- and long-term neonatal morbidity. Weekly 17-alpha-hydroxyprogesterone caproate (17P) injections effectively decrease the risk of recurrent preterm birth (PTB). Despite strong evidence supporting its use, 17P remains underutilized. Data regarding administration of 17P in Medicaid populations is limited. We sought to determine the utilization of 17P in a Texas Medicaid population.
The ICD-9 diagnosis code v23.41 (pregnancy with history of PTB) was used to identify all potential 17P candidates receiving prenatal care at two large Medicaid clinics. Each clinic has dedicated OB Care Coordinators for management of patients with prior PTB. Charts were reviewed to determine utilization and timing of 17P administration.
Eighty-one patients were identified using the administrative code. Of these patients, 71.6% had a prior spontaneous preterm birth and were therefore eligible to receive 17P. Of the 58 eligible patients, the utilization rate was 62.1% (N=36). Gestational age at initiation of 17P ranged from 16 to 24.6 weeks with 66.7% (N=24) initiating prior to 20 weeks. Eligible patients did not receive 17P due to late entry into prenatal care (15.5%), pregnancy loss (5.2%), transfer from the practice (6.9%) and patient refusal of 17P (10.3%).
Despite a concerted program to maximize 17P administration in a Medicaid population, this important medical intervention remained underutilized. Opportunities to increase administration of 17P include early enrollment into prenatal care and educational initiatives to reduce patient refusal.
Baylor College of Medicine, Houston, TX
Financial Disclosure: The authors did not report any potential conflicts of interest.