Effect of Progesterone as a Tocolytic and in Maintenance Therapy during Preterm Labor

Arıkan, İlker; Barut, Aykut; Harma, Mehmet; Harma, Ibrahim Mehmet

doi:10.1159/000328719

Cited by 45 publications

(72 citation statements)

References 30 publications

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“…[19][20][21][22][23][24][25][26][27][28][29][30] But there are few studies regarding role of progesterone in threatened PTL. [34][35][36][37][38][39] Most of the studies compared the effect of progesterone as a maintainance tocolytic with placebo after initial tocolysis with other agents. There are very few studies compairing the different routes of use of progeterone.…”

Section: Results and Analysismentioning

confidence: 99%

Comparative Study to Assess the Efficacy Between Intramuscular and Vaginal Micronized Progesterone to Prevent Threatened Premature Labour

Patra¹,

Chattopadhyay²,

Munsi³

et al. 2015

jemds

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Preterm birth remains a major clinical problem. Prematurity is not only a major cause of perinatal mortality but also leads to greater risk for short and long term complications including disability and impediments in growth and mental development. To compare vaginal with intramuscular progesterone administration to prevent preterm labor and to detect the effect of both on the uterine and foetal circulations. STUDY DESIGN: comparative interventional study. POPULATION: 100 pregnant women attending NRSMCH Kolkata, Obstetrics emergency with threatened preterm labour before 34 weeks of gestation. STUDY PERIOD: one year. METHODS: Gestational age was confirmed clinically and by USG of early weeks of gestation. Efficacy and tolerability of progesterone in two routes i.e., intramuscular and vaginal for prevention of threatened preterm labour were compared. OUTCOME: Ante partum, intrapartum and perinatal outcomes were compared between two groups by statistical analysis of data's using chi-square test and student-t test. CONCLUSION: Vaginal progesterone was as effective as intramuscular progesterone in reducing preterm birth with fewer side effects in favor of vaginal route.

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Section: Results and Analysismentioning

confidence: 99%

Comparative Study to Assess the Efficacy Between Intramuscular and Vaginal Micronized Progesterone to Prevent Threatened Premature Labour

Patra¹,

Chattopadhyay²,

Munsi³

et al. 2015

jemds

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“…In various studies improvement in birth weight ranged from 290-490 gms. 11,[13][14][15]18 NICU admission were also less in study group(14% vs 24%) with shorter nursery stay(7.71 vs 8.41 days).Neonatal complications like RDS, sepsis, mechanical ventilation were also less in study group. There was one case of neonatal death in Group II.…”

Section: Discussionmentioning

confidence: 72%

“…Results are similar as reported in literature though progesterone, dose and route are different in various studies. 11,[13][14][15][16] Borna et al reported difference in prolongation of pregnancy by 11.5 days while Gargari et al reported it to be 2.6 weeks. Bomba-Opon et al observed a significant reduction in delivery before 34 weeks with vaginal progesterone (9.8% in progesterone group versus 35.3% in control group; p = 0.002).…”

Section: Discussionmentioning

confidence: 99%

The role of micronized progesterone in preterm labour

2020

IJOGR

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Objective: To study the role of intravaginal micronized progesterone in preterm labour in prolonging the pregnancy up to term and thus improving neonatal outcome Materials and Methods: A prospective randomized study wherein 100 pregnant women between 26-34 weeks of pregnancy admitted to labour ward with s/s of preterm labour were included in the study. After initial management with tocolytics and antenatal steroids, when the labour got arrested these women were randomly divided into two groups 1and 2. Group 1 received 200 ug of intravaginal micronized progesterone from inclusion in the study to 36 weeks or till delivery whichever was earlier.Group 2 received only supportive therapy. None of women received oral tocolytics after initial arrest of labour. All women were followed up till delivery and obstetric outcome noted Primary variables were prolongation of pregnancy from inclusion in study to delivery interval, gestation age at delivery. Neonatal outcome variables were birth weight, need for NICU transfer, length of stay in NICU and neonatal complications The results observed were subjected to statistical analysis by SPSS-13 unpaired student t-test, Mann-Whitney for quantitative variables and Chi-square/fisher exact for qualitative variables Results: The two groups were comparable in term of age, parity and rural/urban status. Baseline presentation characteristics of the two groups such as period of gestation, number of uterine contractions per 10 minutes, cervical dilatation and, cervical effacement were also comparable (p value <0.05). Mean gestational age at delivery in group 1 was significantly more than group 2 (36.808 weeks vs. 34.078 weeks). Patient delivering beyond 37 weeks of gestation were significantly more in group 1 (60%vs 14%). Prolongation of pregnancy was significantly more in group 1, mean no. of days being 34±15.25 and 24.22±12.73 in group 1 & 2 respectively. Neonatal outcome in terms of birth weight was significantly better in group 1.mean birth weight being 2675.2±382.20 and 2393.2±378.05 in group1 and 2 respectively. Neonatal complications in terms of need for NICU admission, RDS, sepsis and mechanical ventilation were more in group 2. Conclusion: In preterm labour once the labour is arrested with tocolytics, intravaginal micronized progesterone therapy is effective in prolonging the pregnancy and thus increasing the gestational age at delivery. Neonatal outcome is improved because of increased birth weight and lesser complications.

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“…Un par de estudios recientes apoyan el uso de progesterona como tocolítico de mantención luego de la frenación aguda con otro fármaco (8,9). Sin embargo, la evidencia es insuficiente para recomendar el uso progesterona como tocolítico de mantención en pacientes con trabajo de parto prematuro, justificando la necesidad de más estudios, de buena calidad, para demostrar la eficacia de progesterona micronizada vía oral para la prolongación del embarazo en los casos de parto prematuro frenado.…”

Section: A Relevancia De La Investigaciónunclassified

“…Realizado entre octubre 2010 y abril 2012. El cál-culo del tamaño muestral se efectuó asumiendo 12 días de desviación estándar, basados en los datos obtenidos en otro estudio que evaluó tocolisis de mantención (9). Así se determinó que era necesario reclutar 42 pacientes por grupo para detectar 12 días de diferencia en tiempo ganado de embarazo, con un nivel de significación de 5% y poder estadís-tico de 80%.…”

Section: B El Estudio (1)unclassified

Tocolisis de mantención con progesterona micronizada oral para la prevención del parto prematuro después de parto prematuro frenado

2014

Rev. chil. obstet. ginecol.

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Tocolisis de mantención con progesterona micronizada oral para la prevención del parto prematuro después de parto prematuro frenado Choudhary M, Suneja A, Vaid NB, Guleria K, Faridi MM. Maintenance tocolisis with oral micronized progesterone for prevention of preterm birth after arrested preterm labor. Int J GynaecolObstet 2014. pii: S0020-7292(14) 00181-7.doi: 10.1016/j.ijgo.2014.01.019. Análisis crítico: Constanza Ralph T, Jorge A. Carvajal C, PhD.Unidad de Medicina Materno-Fetal, División de Obstetricia y Ginecología. Escuela de Medicina. Facultad de Medicina. Pontificia Universidad Católica de Chile. RESUMEN (1)Objetivo: Evaluar la eficacia de la terapia de mantención con progesterona micronizada oral para la prolongación del embarazo en los casos de parto prematuro frenado. Métodos: Noventa mujeres entre 24-34 semanas de embarazo, únicos, con membranas intactas y trabajo de parto prematuro frenado, fueron asignados al azar a recibir progesterona micronizada oral (n = 45) o placebo (n = 45), diariamente hasta las 37 semanas o el parto. Los resultados fueron comparados mediante la prueba t de Student, X 2 , prueba exacta de Fisher y X 2 en rangos. Resultados: Progesterona micronizada oral prolongó significativamente el tiempo de latencia (33,29 ± 22,16 vs 23,07 ± 15,42 días; p=0,013). Análisis de rangos reveló una diferencia significativa en el tiempo medio al parto entre los 2 grupos (p=0,014). Hubo un número significativamente menor de partos prematuros (33% vs 58%, p=0,034) y de recién nacidos bajo peso al nacer (37% vs 64%; p=0,017) y significativamente mayor peso de nacimiento (2,44 ± 0,58 vs 2,14 ± 0,47 kg; p=0,009) en el grupo con progesterona. Los resultados perinatales y efectos adversos fueron similares en los 2 grupos. Conclusión: La tocolisis de mantención con progesterona micronizada oral significativamente prolongó el embarazo y disminuyó el número de partos prematuros. ANÁLISIS DE LA INVESTIGACIÓN A. Relevancia de la investigaciónEl parto prematuro, que corresponde al 10% del total de nacimientos a nivel mundial, es la primera causa de morbimortalidad neonatal (2). Su incidencia en Chile es cercano al 6% (3). La morbimortalidad secundaria a la prematurez ha ido disminuyendo. Lamentablemente, esta reducción no se debe a una mejoría en las estrategias preventivas y terapéuticas de pacientes en riesgo o del manejo del parto prematuro, sino más bien al uso de corticoides y a un avance en el cuidado neonatal de los prematuros (3,4).La morbilidad neonatal de los prematuros depende de varios factores, pero principalmente del peso de nacimiento y de la edad gestacional al nacer (5). El manejo actual incluye uso de corticoides para inducir madurez pulmonar y tocolíticos, lo cual logra prolongar la gestación en 2-7 días, dando espacio para que actúen los corticoides y permitir, en algunos casos, el traslado materno con el fin de facilitar el ingreso del recién nacido a una unidad de cuidados intensivos (UCI) adecuada (6).Existe discusión sobre el beneficio de la tocolisis de mantención luego de la f...

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Effect of Progesterone as a Tocolytic and in Maintenance Therapy during Preterm Labor

Cited by 45 publications

References 30 publications

Comparative Study to Assess the Efficacy Between Intramuscular and Vaginal Micronized Progesterone to Prevent Threatened Premature Labour

Comparative Study to Assess the Efficacy Between Intramuscular and Vaginal Micronized Progesterone to Prevent Threatened Premature Labour

The role of micronized progesterone in preterm labour

Tocolisis de mantención con progesterona micronizada oral para la prevención del parto prematuro después de parto prematuro frenado

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