ABSTRACT
Abstract Objective The present study aims to determine if the use of cervical pessary plus progesterone in short-cervix (≤ 25 mm) dichorionic-diamniotic (DC-DA) twin pregnancies is equivalent to the rate of preterm births (PBs) with no intervention in unselected DC-DA twin pregnancies. Methods A historical cohort study was performed between 2010 and 2018, including a total of 57 pregnant women with DC-DA twin pregnancies. The women admitted from 2010 to 2012 (n = 32) received no treatment, and were not selected by cervical length (Non-Treated group, NTG), whereas those admitted from 2013 to 2018 (n = 25), were routinely submitted to cervical pessary plus progesterone after the diagnosis of short cervix from the 18th to the 27th weeks of gestation (Pessary-Progesterone group, PPG). The primary outcome analyzed was the rate of PBs before 34 weeks. Results There were no statistical differences between the NTG and the PPG regarding PB < 34 weeks (18.8%; versus 40.0%; respectively; p = 0.07) and the mean birthweight of the smallest twin (2,037 ± 425 g versus 2,195 ± 665 g; p = 0.327). The Kaplan-Meyer Survival analysis was performed, and there were no differences between the groups before 31.5 weeks. Logistic regression showed that a previous PB (< 37 weeks) presented an odds ratio (OR) of 15.951 (95%; confidence interval [95%;CI]: 1.294-196.557; p = 0.031*) for PB < 34 weeks in the PPG. Conclusion In DC-DA twin pregnancies with a short cervix, (which means a higher risk of PB), the treatment with cervical pessary plus progesterone could be considered equivalent in several aspects related to PB in the NTG, despite the big difference between these groups.
Resumo Objetivo Este estudo tem como objetivo determinar se o uso de pessário cervical associado a progesterona em gestações de gêmeos dicoriônicos-diamnióticos (DC-DAs) com colo do útero curto (≤ 25 mm) apresenta taxa de parto prematuro (PP) equivalente à de gestações gemelares DC-DA sem nenhuma intervenção/não selecionadas. Métodos Um estudo de coorte histórica foi realizado entre 2010 e 2018, incluindo um total de 57 mulheres grávidas com gestações gemelares DC-DA. As mulheres admitidas de 2010 a 2012 (n = 32) não receberam tratamento, e não foram selecionadas pelo comprimento cervical (grupo Não Tratado, GNT), enquanto as admitidas de 2013 a 2018 (n = 25) receberam pessário cervical rotineiramente associado a progesterona após o diagnóstico de colo curto entre a 18a e a 27ª semanas de gestação (grupo Pessário-Progesterona, GPP). O desfecho primário analisado foi a taxa de PP antes de 34 semanas. Resultados Não houve diferenças estatísticas entre o GNT e o GPP em relação ao PP < 34 semanas (respectivamente, 18,8%; versus 40,0%;; p = 0,07) e ao peso médio ao nascer do gêmeo menor (2.037 ± 425 g versus 2.195 ± 665 g; p = 0,327). A análise de Kaplan-Meyer foi realizada, e não houve diferenças entre os grupos antes de 31,5 semanas. A regressão logística demonstrou que o nascimento prematuro anterior (< 37 semanas) apresentou razão de probabilidades (odds ratio, OR) de 15,951 (intervalo de confiança de 95%; [IC95%;]: 1,294-196,557; p = 0,031*) para o nascimento prematuro < 34 semanas no GPP. Conclusão Em gêmeos DC-DA com colo uterino curto (o que significa maior risco de nascimento prematuro), o tratamento com pessário cervical associado a progesterona pode ser considerado equivalente em diversos aspectos relacionados à prematuridade no GNT, apesar da grande diferença entre os grupos.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Pessaries , Progesterone/administration & dosage , Uterine Cervical Incompetence/therapy , Cervix Uteri/diagnostic imaging , Pregnancy, Twin , Administration, Intravaginal , Cohort Studies , Gestational Age , Treatment Outcome , Premature Birth , Cervical Length MeasurementABSTRACT
Background: Currently preterm labour is one of the most challenging problem faced by both obstetricians and perinatologists, this episode in the course of woman’s pregnancy takes a heavy tool for perinatal mortality which accounts for approximately 50-75%. The incidence of preterm labour is estimated to be 5-10% of all pregnancies.Methods: It was a prospective randomize control trail over a period of 3 year at department of obstetrics and gynecology, tertiary care hospital Pune, Maharashtra, India. Total 100 subjects were randomized into two groups with group one receiving vaginal micronized progesterone and group two control group receiving only tocolytics and steroids. Subsequently authors compared the safety and efficacy of vaginal micronized progesterone versus placebo as a maintenance therapy in preventing preterm labour.Results: This analysis showed that women who randomized to progesterone prophylaxis had a significantly increase in duration of pregnancy. The mean of birthweight in Group A and Group B was 2963±36 gm and 2567±49 gm and respectively which confirmed the positive effects of progesterone on increasing infants’ weights at birth.Conclusions: Authors concluded that progesterone therapy had acceptable efficacy in the prevention of preterm labor in terms of prolongation of delivery and by increasing gestational age at delivery.
ABSTRACT
<p><b>Background</b>Luteal support is a key to patients undergoing in vitro fertilization and embryo transfer (IVF-ET) with gonadotropin-releasing hormone (GnRH)-antagonist protocol. This study aimed to compare the effect between vaginal progesterone (VP) and intramuscular progesterone (IMP) with GnRH-antagonist protocol after IVF-ET.</p><p><b>Methods</b>A total of 1760 patients (18 years ≤ age ≤35 years) undergoing IVF-ET with GnRH-antagonist protocol were studied retrospectively between September 2014 and August 2015 in Peking University Third Hospital. In the patients, 1341 patients received VP (VP group) and 419 patients received IMP (IMP group) as luteal support. We compared clinical outcomes between these two groups. The primary objective of the study was the live birth rate. Measurement data between the two groups were conducted using independent samples t-test. The variables in line with non-normal distribution were expressed as median (p25 and p75) and were compared using nonparametric Mann-Whitney U-test.</p><p><b>Results</b>Live birth rate in VP group was 38.55%, significantly higher than that in the IMP group, which was 30.79% (χ = 8.287, P = 0.004). The clinical intrauterine pregnancy rate and implantation rate in VP group were also significantly higher than those in the IMP group (clinical intrauterine pregnancy rate 47.35% vs. 41.29%, χ = 4.727, P = 0.030; implantation rate 30.99% vs. 25.26%, χ = 14.546, P < 0.001). Any statistically significant differences in ectopic pregnancy and abortion rates between two groups were not observed.</p><p><b>Conclusion</b>: Luteal support with VP had better clinical outcomes for young women undergoing IVF-ET with GnRH-antagonist protocol.</p>
ABSTRACT
Objetivo: evaluar los efectos de la progesterona vaginal combinada con nifedipino en comparación al uso único de Nifedipino en la amenaza de parto pretérmino en gestantes entre 24-34 semanas con longitud cervical ≤ a 25 mm en el Hospital Materno Infantil Germán Urquidi. Método: se realizó un estudio de cohorte, prospectivo, comparativo y analítico. Es un diseño de dos grupos (comparativos) donde la selección de pacientes se hizo de acuerdo a criterios de inclusión y exclusión, se evaluaron 231 pacientes. Resultados: el 67% de las pacientes que usaron progesterona más nifedipino resolvieron el evento de Amenaza de Parto Pretérmino en la primera hora en comparación al 50% de las pacientes que usaron solo nifedipino. Con la combinación de progesterona y nifedipino se controló en 1 hora el episodio de Amenaza de Parto Prematuro entre las 24 a 34 semanas de gestación, con el uso único de nifedipino, desde las 32 - 34 semanas existe un promedio de 2 horas en sobrepasar el episodio. Con solo nifedipino como tocolítico, el 80% de los pacientes verificaron parto a los 5 días. Solamente el 20% lograron sobrepasar los 10 días de latencia. La combinación progesterona y nifedipino logro que el 30% de las pacientes alcanzaran una latencia entre los 21-30 días, La edad gestacional al nacimiento con la combinación progesterona y Nifedipino alcanza en un 80% una edad menor o igual a 37 semanas 6 días. Conclusiones: La combinación de Progesterona vaginal más nifedipino, mejora sustancialmente el pronóstico neonatal en todos los resultados obtenidos, el uso único de nifedipino tiene menores efectos beneficiosos en esta investigación.
Objective: evaluate the effects of Vaginal Progesterone combined with nifedipine compared to the single use of nifedipine in the threat of preterm delivery in pregnant women between 24-34 weeks with cervical length ≤ 25mm in the Hospital Materno Infantil Germán Urquidi. Method: a prospective, comparative and analytical cohort study was conducted. It is a design of two groups (comparative) where the selection of patients was made according to inclusion and exclusion criteria, we evaluated 231 patients. Results: the time to exceed the Preterm Childbirth episode, 67% of the patients who used progesterone plus nifedipine resolved the event within the first hour compared to 50% of patients who used only nifedipine. With the combination of progesterone and nifedipine, the episode of Premature Birth Threat between 24 and 34 weeks of gestation was controlled within 1 hour, with the sole use of nifedipine, from 32-34 weeks there is an average of 2 hours in excess of episode. With only nifedipine as tocolytic, 80% of the patients verified delivery at 5 days. Only 20% were able to exceed 10 days of latency. The combination progesterone + nifedipine achieved that 30% of the patients reached a latency between 21-30 days, Gestational age at birth with the combination progesterone + nifedipino reaches 80% an age less than or equal to 37 weeks 6 days. Conclusions: the combination of vaginal progesterone plus nifedipine substantially improves the neonatal prognosis in all the results obtained, the use of nifedipine alone has less beneficial effects in this investigation.