POSSIBILITIES OF THE TREATMENT OF PRETERM LABOR OF MULTIPLE PREGNANCY BY THE USE OF SUBLINGU AL FORMS OF MICRONIZED PROGESTERONE
DOI:
https://doi.org/10.11603/24116-4944.2018.1.8625Keywords:
multiple pregnancy, miscarriage, sublingual form of micronized progesterone (Lutein), the vaginal form of micronized progesterone, threat of preterm labor.Abstract
The aim of the study – to evaluate the effectiveness of the application of the sublingual form of micronized progesterone (Lutein) in women with multiple pregnancies with a high risk of premature birth.
Materials and Methods. We examined 85 women pregnant with twins with signs of miscarriage in the period of 22 to 36 weeks of gestation, which made the main group, two subgroups were formed: Ia – 43 women, received micronized progesterone sublingually in a complex of treatment of the threat of termination of pregnancy; subgroup Ib – 42 pregnant women who did not receive progesterone medication during treatment. Retrospectively, 40 stories of preterm labor were analyzed in a single pregnancy (comparison group). In the main group, a general clinical and biochemical examination of pregnant women, determination of serum levels of ALT, AST, levels of bilirubin and progesterone was carried out. The analysis of the course of pregnancy, childbirth, the postpartum period and the state of neonatal adaptation of newborns in the examined pregnant women.
Results and Discussion. We proved major risk factors for premature birth in multiple pregnancies, as well as the role of infectious anamnesis, of data the transvaginal cervicometry, incomplete examination and untimely initiation of treatment of the threat of premature birth, insufficient prevention of complications in multiple pregnancies. The dynamics of cervical contraction was significantly slower in Ia subgroup of patients who received micronized progesterone, this is an effective method of preventing and treating miscarriage in women with multiple pregnancies, reducing the frequency of late abortion and premature birth, and perinatal loss. It was found that in women of the main group ALT and AST levels, as well as total bilirubin, did not deviate from the norm. A decrease in the level of progesterone in both subgroups was noted. In pregnant women of Ia subgroup, against the backdrop of treatment with micronized progesterone, a significant increase in the serum level of progesterone was observed on the third day of treatment to (1109±27) nmol / L, and by the end of the first week of treatment, this index increased to (1280±39) nmol / l, while іn Ib subgroup its dynamics did not change (886±29) nmol / l and, accordingly, (891±33) nmol / l). The use of sublingual forms of micronized progesterone in the period of severe clinical symptoms of the threat of premature labor in multiple pregnancies makes it possible to obtain the fastest therapeutic effect, facilitates rapid elimination of clinical symptoms, regression of ultrasound markers of the threat of termination of pregnancy and prevents further progression of structural changes from the cervix.
Conclusions. 1. With signs of the threat of premature delivery of the sublingual form of micronized progesterone, it is possible to quickly restore the serum level of progesterone to physiological indices, thereby reducing the incidence of premature births by and perinatal outcomes in newborns. 2. The use of sublingual form of micronized progesterone in pregnant women with preterm labor does not affect the function of the liver. 3. Complex therapy of the threat of preterm labor with the use of micronized progesterone has a high effectiveness of therapeutic action and can be recommended for wide use, shortens the period of stay in the hospital, reduces the number of complications.
References
Baranov, I.I., Tokova, Z.Z., & Таdevosyan, A.A. (2012). Perinatalnye iskhody pri mnogoplodnykh rodakh [Perynatal result of multiple pregnancy]. Akusherstvo i ginekologiya – Obstetrics and Ggynecology, 1, 98-102 [in Russian].
Vdovychenko, Yu.P. (2011). Bahatoplidna vahitnist: navchalnyi posibnyk [Multifeded pregnancy: a manual. Ch. II (for the teacher))]. Vdovychenko, Yu.P., Hoyda, N.H., & Yuzko, O.M. (Eds.). Kyiv [in Ukrainian].
Zhuk, S.I. (2013). Efektyvne poperedzhennia peredchasnykh polohiv: vid nauky do praktyky [Effective prevention of preterm labor: the bifid of science to practice].
Zhinochyi likar – Woman’s Doctor, 1, (45) [in Ukrainian].
Krasnopolskiy, V.I., Novikov, D.M., Kapustin, S.F., Titchenko, L.I., Aksenov, A.N., & Zharova, A.A. (2009). Sovremennyye problemy mnogoplodnoy beremennosti [Modern
problems of multiple pregnancy]. Rossiyskiy vestnik akusheraginekologa – Russian Bulletin of Obstetrician Gynecologist, 2, 79-81 [in Russian].
Lapach, S.N., Chubenko, A.V., & Babych, P.N. (2000). Statistycheskye metody v mediko-biologicheskikh issledovanyyakh s ispolzovanyem “Exel” [Statistical methods in biomedical research using “Exel”]. Kyiv: Моriоn [in Russian].
Kaminskiy, V.V., & Onishchuk, L.N. (2015). Primeneniye progesterona v akusherskoy praktike [Application of progesterone in obstetric practice]. Zbirnyk naukovykh prats Asotsiatsii akusheriv-hinekolohiv Ukrainy – Collection of Scientific Works of the Association of Obstetricians-Gynecologists of Ukraine, 1 (35), 5-12 [in Russian].
Reznichenko, G.I. (2013). Profilaktyka nevynoshuvannia vahitnosti i peredchasnykh polohiv [Prevention of miscarriage and premature delivery]. Zhinochyi likar – Woman’s Doctor, 3, 10-14 [in Ukrainian].
Nikitina, I.N., Sukharev, A.В., Boichuk, A.V., & Smiian, S.A. (2016). Osoblyvosti neonatalnoi adaptatsii novonarodzhenykh z dviini [Features of adaptation neonatal infants from twins]. Zhurnal
klinichnykh ta ekperymentalnykh doslidzhen – Journal of Clinical and Experimental Medical Research, (4), 2, 264- 271 [in Ukrainian].
Almonte, L., Davis, М., Ward, С., Brown, D., & Craparo, F. (2012). Spontaneous and non-spontaneous twins: a comparasion study of preterm labor, preterm premature rupture of membranes, gestational age at delivery, maternal age, and len th of. Twin Research and Human Genetics, (15), 2, 170.
Duan, L., Yan, D., Zeng, W., Yang, X., & Wei, Q. (2010). Effect of progesterone treatment due to threatened abortion in early pregnancy for obstetric and perinatal outcome. Early Human Development, 6, 41-43.
Schuit, E., Stock, S., Rode, L. Rouse, D.J., Lim, A.C., Norman, J.E. ... Global Obstetrics Network (GONet) collaboration. (2015). Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participan data metaanalisis. British Journal of Obstetrics and Gynecology, 122 (1), 27-37. doi: 10.1111/1471-0528.13032.
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