• Efficacy of Utrogestan for cervical shortening

Efficacy of Utrogestan for cervical shortening

PERINATOLOGY AND PEDIATRIC. UKRAINE. 2017.3(71):60-64; doi 10.15574/PP.2017.71.60

Ohorodnyk A. O., Butenko L. P., Limanskaya А. Yu., Davydova Iu. V.
SI «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv

Objective — to evaluate the efficacy of preterm delivery combined prevention using the micronised progesterone (Utrogestan) and corrective techniques of cervix.
Material and methods. The study included 68 pregnant women at high risk of thromboembolic complications. This cohort of women had ultrasound signs of cervical shortening (<25 mm) from the first trimester and was divided into three groups: group I (15 patients) was administered the comprehensive treatment, aimed at the pregnancy prolongation without using progesterone drugs, group II (25 pregnants) received the comprehensive treatment and micronized progesterone (Utrogestan, intravaginal introduction), 200-400 mg up to 16 weeks of gestation; group III (18 pregnants) received the comprehensive treatment and micronized progesterone (Utrogestan, intravaginal introduction), 200-400 mg up to 35-36 weeks of gestation.
Results. The threatened miscarriage in the first trimester has a negative impact on the function of the fetoplacental complex and significantly impairs the gestation course and prognosis for newborn. Inclusion of micronized progesterone agents in the integrated management of the threatened miscarriage from early pregnancy significantly improves the gestation course and its consequences. If necessary, the long-term therapy with micronized progesterone Utrogestan should be continued at the outpatient pregnancy follow-up after hospital discharge, despite the cervical cerclage or pessary. The unreasonable suspension of hormonal therapy often leads to the re-hospitalization with increased clinical manifestations of the threatened miscarriage or premature delivery.
Conclusions. Micronized progesterone (Utrogestan) has a proven benefit-risk profile for long-term usage in pregnant women, can be efficient for the treatment of high-risk pregnant women.
Key words: miscarriage prevention, micronized progesterone.

References

1. Nicolaides KH, Syngelaki A, Poon LC et al. (2016, Mar 17). A Randomized Trial of a Cervical Pessary to Prevent Preterm Singleton Birth. J N Engl J Med. 374(11): 1044—1052. https://doi.org/10.1056/NEJMoa1511014; PMid:26981934

2. Carlan SJ, Richmond LB, O'Brien WF. (1997). Randomized trial of endovaginal ultrasound in preterm premature rupture of membranes. Obstet Gynecol. 89: 458—461. [PubMed] https://doi.org/10.1016/S0029-7844(97)00002-1

3. Gomez R, Romero R, Medina L et al. (2005). Cervicovaginal fibronectin improves the prediction of preterm delivery based on sonographic cervical length in patients with preterm uterine contractions and intact membranes. Am J Obstet Gynecol. 192: 350—359. https://doi.org/10.1016/j.ajog.2004.09.034; PMid:15695971

4. Clement S, Candy B, Heath V. (2003). Transvaginal ultrasound in pregnancy: its acceptability to women and maternal psychological morbidity. Ultrasound Obstet Gynecol. 22; 508—514. https://doi.org/10.1002/uog.893; PMid:14618665

5. Peaceman AM, Andrews WW, Thorp JM et al. (1997). Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial. Am J Obstet Gynecol. 177: 13—18. [PubMed] https://doi.org/10.1016/S0002-9378(97)70431-9

6. Iams JD, Casal D, McGregor JA et al. (1995). Fetal fibronectin improves the accuracy of diagnosis of preterm labor. Am J Obstet Gynecol. 173: 141—145. https://doi.org/10.1016/0002-9378(95)90182-5

7. Lockwood CJ, Senyei AE, Dische MR et al. (1991). Fetal fibronectin in cervical and vaginal secretions as a predictor of preterm delivery. N Engl J Med. 325: 669—674. https://doi.org/10.1056/NEJM199109053251001; PMid:1870640

8. Iams JD. (2003). Prediction and early detection of preterm labor. Obstet Gynecol. 101: 402-412. https://doi.org/10.1097/00006250-200302000-00030; https://doi.org/10.1016/S0029-7844(02)02505-X

9. Krebs-Jimenez J, Neubert AG. (2002). The microbiological effects of endovaginal sonographic assessment of cervical length. J Ultrasound Med. 21: 727—729. https://doi.org/10.7863/jum.2002.21.7.727; PMid:12099559

10. Lockwood CJ. (1994). Recent advances in elucidating the pathogenesis of preterm delivery, the detection of patients at risk, and preventative therapies. Curr Opin Obstet Gynecol. 6: 7—18. https://doi.org/10.1097/00001703-199402000-00003; PMid:8180354

11. Peltier MR. (2003). Immunology of term and preterm labor. Reprod Biol Endocrinol. 1: 122. https://doi.org/10.1186/1477-7827-1-122; PMid:14651749 PMCid:PMC305338

12. Revah A, Hannah ME., Sue AQAK. (1998). Fetal fibronectin as a predictor of preterm birth: an overview. Am J Perinatol. 15: 613—621. https://doi.org/10.1055/s-2007-994079; PMid:10064202

13. Ananth CV, Joseph KS, Oyelese Y et al. (2005). Trends in preterm birth and perinatal mortality among singletons. United States, 1989 through 2000. Obstet Gynecol. 105: 1084—1091. https://doi.org/10.1097/01.AOG.0000158124.96300.c7; PMid:15863548