THE EFFECT OF RECTAL PROGESTERONE ON DOPPLER PARAMETERS OF THE UTERINE ARTERIES FOR THE PREVENTION OF PRETERM DELIVERY IN IRAQI POPULATION
DOI:
https://doi.org/10.22159/ajpcr.2018.v11i10.28951Keywords:
Preterm labor, Progesterone, Doppler studyAbstract
Objective: The effectiveness of progesterone in the prevention of threatened preterm labor has been established for many years, but the preferable route, dose, and duration of treatment are until now under the evaluation of researches. The aim of this study was to determine the effect of rectal progesterone on Doppler indices of the uterine arteries in pregnant women with threatened preterm delivery.
Methods: A prospective case–control study was conducted at the obstetric ward and the Outpatients Department of Al-Yarmouk Teaching Hospital in Baghdad for the period of 1 year from April 1, 2017, to April 1, 2018. 100 women were enrolled in the study, 50 of them were pregnant women with a diagnosis of preterm labor assigned as a study group and the other 50 were apparently healthy pregnant women of the same gestational age assigned as a control group. Doppler study of uterine arteries was done to all participants, and the results were compared for both groups. The patients with preterm labor received nifedipine tocolysis initially until contractions subsided and Doppler study had been repeated for those women after 1 week of rectal progesterone therapy.
Results: The study group had a significantly higher resistance index (RI) than the control group (0.58 vs. 0.52) as p<0.05, in spite of the pulsatility index (PI) being higher for the study group compared to the control group (0.78 vs. 0.77) but this difference was not statistically significant. The RI before the therapy (0.58) was significantly higher than the index after therapy (0.52), and the PI was again significantly higher before therapy (0.78) than after therapy (0.71) as p<0.05. During the follow-up period, 3 (6.5%), 4 (8.7), and 39 (84.8%) patients delivered within 1 week, after 1 week, and at term, respectively.
Conclusion: Rectal progesterone can arrest threatened preterm labor, and this effect is possible in part explained by its action on uterine arteries.
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References
Johnson MR. Preterm birth. In: Kenny LC, Myers JE, editors. Obstetrics by Ten Teachers. 20th ed. USA: CRC Press; 2017. p. 222-3.
Taylor M, Rundle S. Preterm birth. In: Luesley DM, Kilby MD, editors. Obstetrics and Gynecology an Evidence based text for the MRCOG. 3rd ed. USA: CRC Press; 2016. p. 328.
Obstetrics Guidelines, April 2017. p. 4.
Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Nannini A, Weiss J, et al. Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics 2008;121:e223-32.
Olgan S, Celiloglu M. Contraction-based uterine artery doppler velocimetry: Novel approach for prediction of preterm birth in women with threatened preterm labor. Ultrasound Obstet Gynecol 2016;48:757-64.
ACOG Committee Opinion No. 419 October 2008. Use of progesterone to reduce preterm birth. Obstet Gynecol 2008;112:963-5.
Dodd JM, Jones L, Flenady V, Cincotta R, Crowther CA. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane Database Syst Rev 2013;7:CD004947.
Areia AL, Vale-Pereira S, Vaz-Ambrósio A, Alves V, Rodrigues- Santos P, Rosa MS, et al. Does progesterone administration in preterm labor influence treg cells? J Perinat Med 2016;44:605-11.
Vafaei H, Zamanpour T, Raeisi Shahraki H. Preterm birth prevention: Effects of vaginal progesterone administration on blood flow impedance in uterine-fetal circulation by doppler sonography. Glob J Health Sci 2015;8:172-8.
Hitesh VP, Nayana HP, Nilofar RS. Vitamin D receptor (VDR) gene polymorphism and maternal vitamin d deficiency in Indian women with preterm birth. Asian J Pharm Clin Res 2017;10:219-23.
Palacio M, Cobo T, Antolın E, Ramirez M, Cabrera F, Mozo de Rosales F, et al. Vaginal progesterone as maintenance treatment after an episode of preterm labour (PROMISE)study: A multicenter, double-blind, randomized placebo-controlled trial. BJOG 2016;123:1990-9.
Rashmi A, Anupa S, Anita P, Rita M. Role of micronized progesterone in prevention of preterm labour in women with previous history of one or more preterm births: A research study at a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol 2015;4:1176-80.
Fadwah T, Mohammed B, Abdulelah N, Yasir K, Irfanallah MS, Fawaz E, et al. The effect of rectal progesterone on latency period as well as maternal and prenatal outcome between 24 to 33 weeks. Int J Clin Trials 2015;2:97-101.
Ruchika G, Urvashi V, Rajni R, Somya SH, Renui R. Progesterone and prevention of preterm labor. Indian J Clin Pract 2014;25:4.
Emily A, Christine D, James V. Progesterone administration for the prevention of preterm birth: Effect on uterine blood flow dynamics. AJOG 2016;1:293-4.
Lucovnik M, Trojner Bregar A, Bombac L, Gersak K, Garfield RE. Effects of vaginal progesterone for maintenance tocolysis on uterine electrical activity. J Obstet Gynaecol Res 2018;44:408-16.
Titaley RC, Rahayu E, Damayanti R, Dachlia D, Sartika DA, Ismail A, et al. Association between knowledge and complication of taking iron/folid acid supplement during pregnancy. Asian J Pharm Clin Res 2017;10:181.
Katmini K, Murti B, Oepomo TD, Anantanyu S. Path analysis on the effect of social capital on the empowerment of pregnant women in preeclampsia prevention using preceede-proceede in Kediri East Java, Indonesia. Asian J Pharm Clin Res 2018;11:271-3.
Asthana GS, Asthana A. Biotransformation of progesterone to 17α-hydroxy progesterone by using plant cell suspension culture of Catharanthus roseus. Int J Pharm Pharm Sci 2015;7:362-8.
Vonnkho J, Chua SS, Dallumal RM, Omar SZ. Medications used by pregnant women: Any safety concerns? Int J Pharm Pharm Sci 2017;9:100-6.
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