Efficacy of vaginal progesterone for maintenance tocolysis: a recent trend in the management of arrested preterm labour

Preterm birth is a leading cause of perinatal morbidity and mortality worldwide. Women with preterm labour that is halted with tocolytic therapy are at increased risk of recurrence. However, there is insufficient evidence to justify the use of maintenance tocolytic therapy after successful arrest of preterm labour. The objective of this study was to determine whether supplementation of vaginal progesterone, after inhibition of preterm labour, is associated with prolongation of gestation and subsequent improvement in neonatal outcome. Setting. OB/GYN casuality ward of Kasr Al Aini Teaching Hospital in Cairo, This trial included 40 women presenting with symptoms of threatened preterm labour, whom after arrest of uterine activity were then randomized to progesterone therapy or no treatment. Treatment group received progesterone suppository [200mg] twice daily until delivery and control group received no treatment. The primary outcome was latency period and recurrent preterm labour. The secondary outcome was birth weight and neonatal morbidity. The progesterone group had significantly longer meanlatencyuntil delivery [8.3 +/- 1.9 weeks Vs 5.0 +/- 1.2 weeks] [mean +/- standard deviation]; less recurrent preterm labour 3 [15%] Vs 9 [45%] and higher birth weight [2.6 +/- 0.4kg Vs 1.9 +/- 0.2kg, p=<0.00l]. The overall neonatal morbidity was not significantly different between the two groups. The use of vaginal progesterone suppository after successful parenteral tocolysis is associated with a longer latency preceding delivery and a lower incidence of recurrent preterm labour. However, progesterone therapy failed to lead to a significant improvement in the overall neonatal outcome

Letrozole compared to clomiphene citrate in patients with unexplained infertility undergoing IUI

To compare the efficacy of Ietrozole as ovulation induction agent for patients with unexplained infertility as regards is mean number of follicles resulting, endumetrial thickness and pregnancy rate [PR] in comparison to CC alone and in combination with gonadotropines [HMG] and Ietrozole in combination with HMG for COH and IUI A prospective randomized comparative study. Infertility outpatient clinic, Faculty of Medicine. Consequtive patients who agreed to participate were randomized on an alternating basis to receive either 2.5 mg bid letrozole or 50 mg bid CC on days 3-7, or letrozole followed by HMG, or CC followed by HMG 75IU/day until the day of HCG [15 patients in each group].Folliculometry starting D7 was done till the Ieading follicle[s] reached 18mm ovulation was triggered by HCG 10000 IU and endometrial thickness was measured on the day of HCG administration. A single IUI was done 36 hours after HCG administration. The luteal phase was supported by vaginal micronized progesterone 600 mg/day. Pregnancy was established by blood beta-subunit detection 2 weeks after IUI. A total of 60 patients [15 patients in each group] meeting the inclusion criteria were included All patients had primary unexplained infertility of less than 3 years and there was no statistically significant difference in age nor BMI between the 4 groups. The outcome measures we examined were endometrial thickness, mean number of mature follicles > 18 mm on day of HCG administration and pregnancy rate. The mean endometrial thickness was: 8.8 mm in the letrozole group, 8.3 mm in the CC group, 8.5 mm in the letrozole + HMG group. 9.9 mm in the CC + HMG group i.e. the showed the least mean endometrial thickness but with no statistically significant difference between the 4 groups. mean number of mature follicles >18 mm on the day of HCG was: 3.2 in the letrozole group. 2 6 in the CC group, 2.4 in the letrozole + HMG group .3.4 in the CC + HMG group with no statistically significant difference between the 4 groups. Pregnancy rate per cycle for the 4 groups was: 20% in the letrozole group, 40% in the CC' group, 13.3% in the letrozole + HMG group, 26.7% in the CC + HMG group with no statistically significant difference between the 4 groups. In conclusion we tailed to prove that there is clinical preference of Ietrozole or combined protocols over CC alone in COH + IUI or women with unexplained infertility, this could be attributed to the small sample size, bigger study is needed before Ietrozole is prescribed as a first- line induction drug being more expensive than CC