The combined use of various forms of micronized progesterone in the treatment of the threat of termination of pregnancy in multiple pregnancies

Authors

DOI:

https://doi.org/10.18370/2309-4117.2017.35.68-73

Keywords:

multiple pregnancy, sublingual form of micronized progesterone, vaginal form of micronized progesterone, threat of premature birth, Luteina

Abstract

The article highlights the data on the features of the etiology and pathogenesis of the threat of premature birth in a multiple pregnancy. The results of a clinical study of the effectiveness of combined therapy in the threat of termination of pregnancy in women with multiple pregnancies with sublingual and vaginal forms of micronized progesterone are presented.

In the course of the study 120 twins pregnancies with signs of miscarriage in terms of 14–28 weeks were analyzed. The first group consisted of 40 women who were offered a sublingual form of natural micronized progesterone in combination with the vaginal form (drug Luteina) in the scheme of treatment and prophylactic measures. The second group included 40 women, who received a synthetic progesterone preparation (dydrogesterone) for treatment of the threat of termination of pregnancy. The control group consisted of 40 pregnant women, who were treated according to the current clinical protocols.

The results of the study showed that the effect of the use of the sublingual form of micronized progesterone in the period of severe clinical symptoms of the threat of premature delivery in multiple pregnancy came out twice as fast compared to the oral form of synthetic dydrogesterone, what contributes the rapid elimination of clinical symptoms, regression of ultrasound markers of the threat of miscarriages and prevents further progression of cervix structural changes. The presence of sublingual and vaginal form of micronized progesterone allows, if necessary, to go from one form to another, and also combine both forms to quickly saturate the body of pregnant woman by progesterone in conditions of gestagen deficiency in order to eliminate the symptoms of the threat of pregnancy termination.

Therefore, complex therapy of the threat of premature birth with the use of sublingual and vaginal forms of micronized progesterone has a significant therapeutic effect, contributes to a shorter period of inpatient stay, a reduction in the number of complications compared to other progestins and can be recommended for widespread use. The use of natural micronized progesterone in women with the threat of interruption of pregnancy in multiple pregnancies significantly reduces the risk of preterm labor and improves perinatal outcomes.

Author Biography

І. М. Нікітіна, Sumy State University

PhD, associate professor at the Obstetrics and Gynecology Department 

References

  1. Baranov, I.I., Tokova, Z.Z., Tadevosyan, A.A. “Perinatal outcomes in multiple births.” Obstetrics and Gynecology 1 (2012): 98–102.
  2. Vdovychenko, Y.P. Multiple pregnancy: a tutorial. Part II (For teacher) / Ed. by Y.P. Vdovychenko, N.H. Goyda, O.M. Yuzko. Kyiv (2011): 360 p.
  3. Krasnopolskyi, V.I., Novikova, S.V., Kapustina, M.V., et al. “Modern problems of multiple pregnancies.” Russian bulletin of the obstetrician-gynecologist 2 (2009): 79–81.
  4. Lapach, S.N., Chubenko, A.V., Babich, P.N. Statistical methods in biomedical research using Excel. Кyiv. Morion (2000): 320 p.
  5. Mayorov, M.V. “Gestagens in obstetrical and gynecological practice.” The pharmacist 7 (2004): 26–29.
  6. Almonte, L., Davis, M., Ward, C., et al. “Spontaneous and non-spontaneous twins: a comparasion study of preterm labor, preterm premature rupture of membranes, gestational age at delivery, maternal age, and len th of hospital stay.” Twin Research and Human Genetics 15.2 (2012): 170.
  7. Hassan, S.S., Romero, R., Vidyadhari, D., et al. “Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, doubleblind, placebocontrolled trial.” Ultrasound in Obstetrics & Gynecology 38.1 (2011): 18–31.
  8. Goldenberg, R.L., Iams, J.D., Mercer, B.M., et al. “The preterm prediction study: the value of new vs. standard risk factors in predicting early and all spontaneous preterm births.” Am J Public Health 88 (1998): 233–8.
  9. American College of Obstetricians and Gynecologists. “Practice Bulletin No. 127. Management of preterm labor.” Obstet Gynecol 119 (2012):1308–13.
  10. Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA, and The World Bank. Geneva. World Health Organization (2007).
  11. 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 morbidity: a systematic review and metaanalysis of individual patient data.” Am J Obstet Gynecol 206.2 (2012): 124.e1–19.
  12. Salazar, E.L., Calzada, L. “The role of progesterone in endometrial estradiol and progesterone-receptor synthesis in women with menstrual disorders and nabitual abortion.” Gynecol Endocrinol 23.4 (2007): 222–5.
  13. Szekeres-Bartho, J., Kilar, F., Falkay, G., et al. “Progesterone – treated limphocytes of healthy pregnant women release, a factor inhibiting, cytotoxicity and prostaglandin synthesis.” Am J Reprod Immunol 9 (1985): 15–19.
  14. Szekeres-Bartho, J., Barakonyi, A., Par, G., et al. “Progesterone as an immunomodulatory molecule.” Jnt Immunopharmacol 1.6 (2001): 1037–48.
  15. American College of Obstetricians and Gynecologists. “Use of progesterone to reduce preterm birth.” Obstet Gynecol 112 (2008): 963–5.
  16. Order of the MOH of Ukraine No. 624 from 03.11.2008. On amendments to the MOH of Ukraine orders No. 582 from 15.12.2003 and No. 676 from 31.12.2004. “On approval of clinical protocols for obstetric and gynecological care.»

Published

2017-06-21

How to Cite

Нікітіна, І. М. (2017). The combined use of various forms of micronized progesterone in the treatment of the threat of termination of pregnancy in multiple pregnancies. REPRODUCTIVE ENDOCRINOLOGY, (35), 68–73. https://doi.org/10.18370/2309-4117.2017.35.68-73

Issue

Section

Pregnancy and childbirth