• Pathogenetic approach of preterm labour treatment in the background of chronic infection source

Pathogenetic approach of preterm labour treatment in the background of chronic infection source

HEALTH OF WOMAN. 2017.3(119):54–58; doi 10.15574/HW.2017.119.54

Heryak S. N., Petrenko N. V., Dobryanskа V. Yu., Yakimchuk O. A.
SHEI «Ternopil state medical University Horbachevsky of the MH of Ukraine»

The objective was to study the effectiveness of the application of the sublingual form of micronized progesterone for the treatment and prevention of premature birth in women with concomitant risk factors against the background of the infectious inflammatory component in the anamnesis.

Materials and methods. The study was conducted in two stages. At the first stage, 100 stories of pregnant women with preterm labor were analyzed at a period of 22-36 weeks, which were inpatient treatment in the Ternopil Regional Clinical Perinatal Center «Mother and Child». A comprehensive assessment of risk factors for the development of preterm labor and the effectiveness of their management was carried out. At the second stage of the study, 27 pregnant women (group 1) who were hospitalized with a threat of premature birth and had an anamnesis history, were treated with natural micronized progesterone Lutein in a dose of 100 mg sublingually twice a day. The comparison group (group 2) included 30 pregnant women, who before traditional hospitalization began traditional tocolytic therapy with calcium channel blockers. The control group included 20 pregnant women with a physiological pregnancy.

Results. As a result of the proposed therapy, a decrease in the intensity of the pain syndrome in patients taking micronized progesterone was observed at 25 min faster (p <0.05) than after conventional therapy (85.2 ± 7.4 min in the 1st group and 110.6 ± 9.8 min – in the second group). At the same time, anxiety level was 16.1 ± 1.8 points in patients of the 1st group, which corresponded to its absence, while the patients of the 2nd group continued to be in a state of moderate anxiety (19.3 ± 1.4 points). Pregnant women with a threat of preterm birth who had an inflammatory process of any localization in the past had a significant increase in the level of proinflammatory cytokines (IL-2, IL-6, TNF-?) and a decrease in the level of anti-inflammatory cytokines (IL-4, IL- 10) in comparison with the indicators of healthy pregnant women. The use of micronized progesterone and conventional therapy positively affects these indicators.

Conclusion. The use of the sublingual form of micronized progesterone in the preparation of Lutein at a dose of 200 mg per day is pathogenetically grounded and provides a rapid arrest of the manifestations of premature birth in women with miscarriage in the background of chronic foci of infection.

Key words: premature birth, inflammation, micronized progesterone.

REFERENCES

1. Heryak SM, Kutsenko AV, Kutsenko IV. 2016. Metabolichnyi syndrom i vahitnist: monohrafiia. Ternopil: Pidruchnyky i posibnyky: 136, il. 

2. Lukaev AA, Pastarnak AYu, Bolibok NV, Orazmuradov AA. 2014. Rodorazreshenie zhenschin s prezhdevremennyimi rodami. Sovremennyie problemyi nauki i obrazovaniya 2:24-31.

3. Makarov OV, Bahareva IV, Kuznetsov PA, Romanovskaya VV. 2009. Sovremennyie podhodyi k prognozirovaniyu prezhdevremennyih rodov. Ros. vestnik akusherstva i ginekologii 2:10–15.

4. Heryak SN, Petrenko NV, Kuziv IYa, Stelmakh OY, Bagniy NI, Korda IV, Dobryanska VYu, Bagniy LV. 2016. Complex approach to treatment of subchorionic hematoma in early threatened abortion. International Journal of Medicine and Medical Research 2;1:9–12. https://doi.org/10.11603/ijmmr.2413-6077.2016.1.6372

5. Radzinskiy VE, Zapertova EYu. 2004. Progesteronobuslovlennyie izmeneniya provospalitelnyih tsitokinov pri privyichnom nevyinashivanii beremennosti. RMZh 13:764.

6. Areia A, Fonseca E, Moura P. 2013. Progesterone use after successful treatment of threatened pre-term delivery. J Obstet Gynecol. 33:678–681. https://doi.org/10.3109/01443615.2013.820266; PMid:24127952

7. Arikan I, Barut A, Harma M, Harma IM. 2011. Effect of progesterone as a tocolytic and in maintenance therapy during preterm labor. Gynecol Obstet Invest. 72:269–273. https://doi.org/10.1159/000328719; PMid:22086108

8. Choudhary M, Suneja A, Vaid NB, Guleria K, Faridi MM. 2014. Maintenance tocolysis with oral micronized progesterone for prevention of preterm birth after arrested preterm labor. Int J Gynaecol Obstet. 126:60–63. https://doi.org/10.1016/j.ijgo.2014.01.019; PMid:24807871

9. Goldenberg RL, Culhane JF, Iams JD, Romero R. 2008, January 5. Epidemiology and causes of preterm birth. The Lancet. Preterm Birth: 188-195.

10. Haas DM, Caldwell DM, Kirkpatrick P, McIntosh JJ, Welton NJ. 2012. Tocolytic therapy for preterm delivery: systematic review and network meta-analysis. BMJ. 345:6226. https://doi.org/10.1136/bmj.e6226; PMid:23048010 PMCid:PMC4688428

11. Iams JD, Romero R, Culhane JF, Goldenberg RL. 2008, January 5. Primary, secondary and tertiary interventions to reduce the morbidity and mortality of preterm birth. The Lancet. Preterm Birth: 134-143.

12. Kamat S, Veena P, Rani R. 2014. Comparison of nifedipine and progesterone for maintenance tocolysis after arrested preterm labour. J Obstet Gynecol. 34:322–325. https://doi.org/10.3109/01443615.2013.874407; PMid:24483757

13. Ming-Xia Ding, Luo Xin, Zhang Xue-Mei, Bai Bing, Sun Ju-Xiang, Qi Hong-Bo. 2016, Jun. Progesterone and nifedipine for maintenance tocolysis after arrested preterm labor: A systematic review and meta-analysis of randomized controlled trial. Taiwan J Obstet Gynecol. 55(3):399–404. https://doi.org/10.1016/j.tjog.2015.07.005; PMid:27343323

Содержание журнала Full text of article