1. The Power of Progesterone History and OPQC’s role Presented by Jay D. Iams, MD OPQC OB Lead Hetty C. Walker, RN OPQC Advisor

2. What do you do? 23 yo Non-Hispanic African American woman comes in to health dept seeking care, and states “ I might be pregnant & I have a bad discharge” ? LMP: “It’s been awhile but think I feel movement” Reports 2 prior pregnancies: 1 st resulted in miscarriage Last pregnancy delivery vaginally, & early, ~7 months. Not sure why, “my water just broke”, baby was 3# 5oz, in NICU x 6 wks On palpation, uterus at umbilicus, + FHT’s per Doppler Vag exam: Cervix closed, medium consistency + BV Insurance MCP that expires in 3 months

3. Plan Send her for a dating ultrasound ASAP Order a cervical length ultrasound too –Cervical Length by TV Scan = 18 mm Rx with Prometrium 200mg vaginally every night before bed & after voiding (off label use of oral med) –Start that evening andf continue until 36 wks gestation Schedule prenatal care w/ OB/ MFM ASAP Review signs-symptoms of concern; who to contact Validate address, phone #’s and connect her with Medicaid for Re-Determination

4. How to Counsel Pts & Families about Progesterone Explain a pregnancy can’t exist without it, afterbirth produces it, treatment with just a little bit more reduces risk of another preemie by ~35% further explain via everyday analogy “want to pay full price or do you go to the 35% off sale” Safe for baby & Mom “already marinating in it” Stress importance of taking this daily “works better” Difficult to understand what’s on internet -mixes up information on many kinds of progesterone used for many reasons – ask your doctor or nurse

5. Barriers- too numerous Insurance or no insurance Multiple products Who pays for what When to start (16-24 wks, earlier the better) How long to continue (through 36 wks) Where to obtain- pharmacies do not have like pricing If IM, who administers How to order, which forms, where to send Where to obtain resources Co-pay out of reach what help is available Misinformation

6. Resource OPQC handouts for patients and providers insurance coverage chart www.opqc.net No proprietary rights- steal shamelessly! Leave in waiting areas, exam rooms, explain need for Rx in future pregnancies Call or email Hetty 614-293-8949 Hetty.walker@osumc.edu