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

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

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

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

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

Resource OPQC handouts for patients and providers insurance coverage chart No proprietary rights- steal shamelessly! Leave in waiting areas, exam rooms, explain need for Rx in future pregnancies Call or Hetty