The effectiveness of micronized progesterone sublingual and vaginal forms combined use in the treatment of preterm labor

О. В. Голяновський, А. М. Рубінштейн, М. А. Бачинська

Abstract


The article presents current data about the peculiarities of etiology and pathogenesis, clinics and treatment of preterm labor. The results of the clinical study of the effectiveness of micronized progesterone sublingual and vaginal forms for combined therapy of preterm labor at 22–30 weeks were described.

The study included 60 pregnant women. All patients were divided into 2 groups.

Group I consisted of 30 pregnant women who received magnesian tocolytic therapy; hormone therapy (sublingual form of micronized progesterone, along with a third receiving sublingual form the vaginal form of micronized progesterone was administered), systemic anti-inflammatory therapy.

Group II consisted of 30 pregnant women who received magnesian tocolytic therapy; hormone therapy (oily solution progesterone i.m.), systemic anti-inflammatory therapy.

Discontinuation of progesterone carried out with the 8th day gradually, under the control of ultrasound examination, according to the clinical status of the pregnant.

Following parameters were evaluated: gynecological and obstetric history, complaints, laboratory values, ultrasound parameters, peculiarities of childbirth and the postpartum period.

In the course of treatment there is a rapid regression of clinical symptoms in the first study group. The rates of recovery of normal myometrium tone in the first group were also faster than in the second group. These results indicate better perinatal perspectives in patients treated with combination therapy of preterm labor with the sublingual form of vaginal micronized progesterone compared with pregnant women who received oily solution progesterone i.m.

Thus, sublingual form of micronised progesterone and magnesium therapy during the clinical symptoms of preterm labor has a rapid therapeutic effect and prevent the further progression of structural cervix changes during treatment and in the secondary prevention of preterm birth in women with short cervix (less than 20 mm).


Keywords


the threat preterm labor; sublingual form of micronized progesterone; luteina; vaginal form of micronized progesterone; oil progesterone

References


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Order of the MOH of Ukraine of 31.12.2004 № 676 “On approval of clinical protocols for obstetric and gynecological care”, section “Preterm labor” and change it to № 624 from 03.11.2008.

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.

Goldenberg, R.L., Culhane, J.F., Iams, J.D., Romero, R. “Epidemiology and causes of preterm birth.” The Lancet 371.9606 (2008): 75–84.

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World Health Organization. Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA, and The World Bank. Geneva. WHO (2007).

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.e1–124.19.

Saigal, S., Hoult, L.A., Streiner, D.L., et al. “School difficulties at adolescence in a regional cohort of children who were extremely low birth weight.” Pediatrics 105.2 (2000): 325–31.

Tyson, J.E., Prarikh, N.A., Langer, J., et al. “Intensive care for extreme prematurity: moving beyond gestational age.” N Engl J Med 358.16 (2008): 1672–81.

American College of Obstetricians and Gynecologists. “Use of progesterone to reduce preterm birth.” Obstet Gynecol 112 (2008): 963–5.

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, double-blind, placebo-controlled trial.” Ultrasound in Obstetrics & Gynecology 38.1 (2011): 18–31.


GOST Style Citations


1. Інструкція із застосування препарату лютеіна.

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4. Наказ МОЗ України від 31.12.2004 р. № 676 «Про затвердження клінічних протоколів із акушерської та гінекологічної допомоги», розділ «Передчасні пологи» та зміни до нього № 624 від 03.11.2008 р.

Order of the MOH of Ukraine of 31.12.2004 № 676 “On approval of clinical protocols for obstetric and gynecological care”, section “Preterm labor” and change it to № 624 from 03.11.2008.

5. 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.

6. Goldenberg, R.L., Culhane, J.F., Iams, J.D., Romero, R. “Epidemiology and causes of preterm birth.” The Lancet 371.9606 (2008): 75–84.

7. American College of Obstetricians and Gynecologists. “Management of preterm labor. Practice Bulletin No. 127.” Obstet Gynecol 119 (2012):1308–13.

8. World Health Organization. Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA, and The World Bank. Geneva. WHO (2007).

9. 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.e1–124.19.

10. Saigal, S., Hoult, L.A., Streiner, D.L., et al. “School difficulties at adolescence in a regional cohort of children who were extremely low birth weight.” Pediatrics 105.2 (2000): 325–31.

11. Tyson, J.E., Prarikh, N.A., Langer, J., et al. “Intensive care for extreme prematurity: moving beyond gestational age.” N Engl J Med 358.16 (2008): 1672–81.

12. American College of Obstetricians and Gynecologists. “Use of progesterone to reduce preterm birth.” Obstet Gynecol 112 (2008): 963–5.

13. 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, double-blind, placebo-controlled trial.” Ultrasound in Obstetrics & Gynecology 38.1 (2011): 18–31.





DOI: http://dx.doi.org/10.18370/2309-4117.2016.27.41-46

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ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)