DOI: https://doi.org/10.18370/2309-4117.2019.50.22-28

Actual aspects of vaginal progesterone use to prevent reproductive losses and optimize perinatal outcomes

Л. Г. Назаренко, Е. А. Бибик

Abstract


Miscarriage is a complex socio-medical problem, the relevance of which throughout the world is determined by the stable frequency of spontaneous abortions and premature births for half a century. Premature termination of pregnancy as a typical multifactorial disease regardless of the term has a universal pathogenetic mechanism of realization, which is progesterone deficiency. This justifies the need for subsidies with progesterone drugs for women at the real risk of miscarriage and preterm pregnancy.

The aim of the review is to summarize the information of relevant scientific publications with a high level of evidence on the effectiveness of progesterone drugs to prevent early spontaneous termination of pregnancy and an adverse perinatal outcome. To understand the features of micronized progesterone preparations that guarantee maximum effectiveness, to clarify the points of its application in connection with the risk of prematurity and perinatal outcome have been carried out studies in the world: PROMIS, TRISTAN-1, TRISTAN-2, OPPTIMUM, PRISM.

It is proved that the target groups for progesterone drugs are women with the threat of miscarriage in the early stages, patients with habitual miscarriage. Progesterone preparations (micronized progesterone) are aimed not only at prolonging pregnancy, but also at preventing late complications. To date, strong evidence has been obtained (PRISM, 2019) that vaginal micronized progesterone provides better results: live birth value in the general population of women with bloody discharge in the early period (4153 observations) is 3% more than placebo, best effect obtained women with a history of three or more miscarriages who have a 28% higher chance of a live baby (up to 34 weeks). A change in the system of views on assessing progestogen effectiveness in the treatment of miscarriage (its criterion is a live birth), the best prospects for viability, which is provided by proven safety and a positive effect on perinatal outcomes was noted.


Keywords


miscarriage; spontaneous abortion; premature birth; micronized progesterone

References


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