Placental dysfunction as a predictor of miscarriage

Authors

  • Т. Г. Романенко P.L. Shupik National Medical Academy of the Postgraduate Education, Ukraine

DOI:

https://doi.org/10.18370/2309-4117.2017.33.77-82

Keywords:

placenta, progesterone, placental dysfunction, Utrogestan

Abstract

The article considers the possibilities of influence on the formation of the placenta in order to further prevent the occurrence of irreversible placental dysfunction and prevention of pregnancy loss.

Status of the endometrium before fertilization is progesterone-dependent. Progesterone, with all its defence mechanisms, refers to one of the major hormones that participate in the process of trophoblast invasion. The course of pregnancy depends of this process, because it predicts the conceiving and clearly regulates the development of pregnancy. Achievement an adequate functioning of the placenta is possible only when female organism is sufficient saturated of progestin to ensure the success of pregnancy until delivery on time. To do this, it is advisable to conduct primary prevention – administration of progesterone for 2–3 months before planned pregnancy. With this purpose in clinical practice using micronized progesterone (Utrogestan), which has the most sufficient evidence base and used in all developed countries.

Appointment Utrogestan in the step of pregravid preparation, in the early stages of gestation, and the possibility of its use in the later stages allows to observe the principle of therapy continuity of the natural hormone of pregnancy. Intravaginal route of administration creates conditions for the full implanting and normalization of immune status of patient’s by producing PIBF. The advantages of using of vaginal progesterone are: the targeted delivery to target organs, provision a stable hormonal level in blood serum, the lack of hepatotoxicity, the possibility of use in women with extragenital pathology. By intravaginal route Utrogestan reaches maximum concentration in all layers of the uterus after 4 hours.

It is important to note that today Utrogestan is the only progestin drug, which officially registered in Ukraine for the prevention of preterm birth in women at risk. It’s provide to physicians the necessary legal security and, if necessary, allows to assign the drug from pregravid step and up to 36 weeks of pregnancy.

Author Biography

Т. Г. Романенко, P.L. Shupik National Medical Academy of the Postgraduate Education

MD, professor of Obstetrics and Gynecology Department #1 

References

  1. Strizhakov, A.N., Ignatko, I.V., Timokhina, E.V., Belotserkovtseva, L.D. Fetal growth retardation: Pathogenesis. Diagnostics. Treatment. Obstetric tactics. Moscow. GEOTAR Media (2013): 120 p.
  2. Sidelnikova, V.M. Preparation and maintenance of pregnancy in women with recurrent pregnancy loss. Moscow. MEDpress-inform (2013): 219 p.
  3. Vovk, I.B., Vdovychenko, Y.P., Trokhymovych, O.V. The early reproductive losses. Kyiv (2016): 253 p.
  4. Filippov, O.S. Placental insufficiency. Moscow. MEDpress-inform (2009): 160 p.
  5. Milovanov, A.P. “Pathology of system mother-placenta-fetus: guidelines.” Moscow. Medicine (1999): 448 p.
  6. Pirogova, V.I. “Harmony of hormones.” Caring for a woman 7.55 (2014): 56–7.
  7. Yoshinaga, K. “Research on blastocyst implantation essential factors (BIEFs).” Am J Reprod Immunol 63.6 (2010): 413–24.
  8. Romero, R., Nicolaides, K., Conde-Agudelo, A., et al. “Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidit: a systematic review and metaanalysis of individual patient data.” Am J Obstet Gynecol 206.2 (2012): е1–19.
  9. Romero, R., Nicolaides, K., Conde-Agudelo, A., et al. “Vaginal progesterone decreases preterm birth ≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study.” Ultrasound Obstet Gynecol 48.3 (2016): 308–17. DOI: 10.1002/uog.15953
  10. Romero, R., Hassan, S., et al. “Vaginal progesterone reduced the rate of preterm birth in women with sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial.” Ultrasound Obstet Gynecol 38.1 (2011): 18–31.
  11. Di Renzo, G.C. Prevention and management of preterm labor: the international guidelines. FIGO (2016).
  12. Graham, J.D., Clarcke, C.L. “Physiological action of progesterone in target tissues.” Endocr Rev 18.4 (1997): 502–19.

Downloads

Published

2017-02-24

How to Cite

Романенко, Т. Г. (2017). Placental dysfunction as a predictor of miscarriage. REPRODUCTIVE ENDOCRINOLOGY, (33), 77–82. https://doi.org/10.18370/2309-4117.2017.33.77-82

Issue

No. 33 (2017)

Section

Pregnancy and childbirth

License

Copyright (c) 2017 Т. Г. Романенко

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

    1. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.