17P Quality Improvement Project
A singleton pregnancy refers to a pregnancy with one fetus as opposed to twins/multiples. For singleton pregnancies with a history of spontaneous preterm birth in a prior singleton pregnancy, appropriate use of 17P reduces the risk of recurrent preterm birth up to 42% (Meis, 2003). The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal and Fetal Medicine (SMFM) both recommend progesterone therapy for women with singleton pregnancies who have had a prior spontaneous preterm birth.
Medical professionals are encouraged to screen pregnant women for a history of any prior singleton spontaneous preterm births at the first prenatal visit. This promotes early identification, determination of eligibility, and treatment with 17P. While it is a costly therapy, there is a good return on investment, both human and financial, short term and long term. The total cost of 17P therapy is less than the cost of one day in NICU for a premature baby.
In Minnesota, a coalition was formed in 2016 to reduce the incidence, severity, and disparities of preterm birth through the use of 17P for appropriate women. The coalition partners were the Minnesota Department of Health, Minnesota Perinatal Organization, Minnesota Prematurity Coalition, and March of Dimes. With support from the National Institute for Child Health Quality (NICHQ) Infant Mortality Collaborative Improvement and Innovation Network (IM-CoIIN), the coalition created a quality improvement project to shift the bell curve of when babies are born to the right.
- Collaborative Approach Helps Minnesota Accelerate Improvement (National Institute for Children's Health Quality)
- Progesterone Treatment to Help Prevent Premature Birth (March of Dimes)
Goal of 17P Quality Improvement
Reduce the incidence, severity, and disparity of PTB in Minnesota.
- Increase the number of pregnant women in MN who are screened for risk of preterm birth.
- Increase the number of eligible women who receive 17P injections weekly from 16-20 weeks through 36 weeks gestation to increase the duration of pregnancies.
- Achieve/maintain equity in utilization of progesterone by race/ethnicity.