Progestogens for treatment and prevention of pregnancy disorders

2010 ◽  
Vol 3 (3) ◽  
Author(s):  
Adolf E. Schindler
Keyword(s):  
Premature Birth ◽  
Previous History ◽  
First Trimester ◽  
Study Groups ◽  
Treatment And Prevention ◽  
Maternal Immune System ◽  
Hydroxyprogesterone Caproate ◽  
History Of ◽  
Threatened Abortion ◽  
In Pregnancy

AbstractProgesterone appears to be the dominant hormone not only establishing a proper secretory endometrial development but also adequate decidualization to establish pregnancy and sustain pregnancy development. Progesterone is the natural immunoregulator to control the maternal immune system and not to reject the allogeneic fetus. There are two sources of progesterone: corpus luteum first and placenta later. Three progestogens can be used in pregnancy: (i) progesterone (per os, intravaginal and intramuscular), (ii) dydrogesterone (per os), and (iii) 17α-hydroxyprogesterone caproate (intramuscular). There are three indications, for which these progestogens can be clinically used either for treatment or prevention: (i) first trimester threatened and recurrent (habitual) abortion, (ii) premature labor/premature birth, and (iii) pre-eclampsia (hypertension in pregnancy). The available data are limited and only partially randomized. In threatened abortion the use of progesterone, dydrogesterone and 17α-hydroxyprogesterone caproate leads to a significant improved outcome, when at the time of threatened abortion a viable fetus has been ascertained by ultrasound. For prevention of recurrent abortion there are also some data indicating a significant effect compared with women without progestogen treatment. Prevention of preterm birth by progestogens (progesterone vaginally, orally and 17α-hydroxyprogesterone caproate intramuscularly) was significantly effective. The main study groups include pregnant women with a previous history of premature birth. However, also in women with shortened cervix use of progesterone seems to be helpful. The studies done so far in women with risk factors for pre-eclampsia or established pre-eclampsia were based on parenteral progesterone application. However, new studies are urgently needed.

scholarly journals A study of feto-maternal outcome in bleeding per vaginum in first trimester of pregnancy

2020 ◽  
Vol 9 (3) ◽  
pp. 1191
Author(s):  
Jaydeep J. Bhatu ◽  
Darshil S. Prajapati
Keyword(s):  
Vaginal Bleeding ◽  
Local Population ◽  
Previous History ◽  
Perinatal Outcomes ◽  
First Trimester ◽  
Maternal Complications ◽  
History Of ◽  
Threatened Abortion ◽  
Degree Of Association ◽  
In Pregnancy

Background: Bleeding per vaginum in the first trimester is a common obstetric entity. Four major causes of pathological bleeding in 1st trimester are miscarriage, ectopic pregnancy, implantation bleeding of pregnancy and cervical pathology. The purpose of this study was to investigate and understand the effect of first trimester vaginal bleeding on maternal and perinatal outcomes in the local population to which our hospital serves. Objective of this study was to estimate the degree of association between first-trimester bleeding and miscarriage, pregnancy outcomes in women with threatened abortion, various maternal complications and outcome of labor in pregnancy complicated by first-trimester bleeding and adverse fetal outcomes affected with first trimester bleeding.Methods: This prospective observational study was carried out on 110 women attending hospital with history of first trimester vaginal bleeding at a tertiary health center - sola civil hospital Ahmedabad for a period of twelve months.Results: Majority (69%) of first trimester bleeding occurs in age group of 21-30 years and majority of patients were primigravida constituting 53% out of 110 patients, 48 patients presented with abortions, out of which 26 had threatened abortion and 22 had other abortions. Primi para with previous history of bleeding per vaginum had more chances to go in full term in present pregnancy.Conclusions: Patients presenting with heavy bleeding per vaginum ended up in pregnancy loss and thus a poor outcome. In the presence of sub-chorionic hematoma, the prognosis of pregnancy is greatly affected as the risk of pre-term, IUGR and especially miscarriages increase significantly.

Previous induced abortion and ante-natal depression in primiparae: preliminary report of a survey of mental health in pregnancy

1978 ◽  
Vol 8 (4) ◽  
pp. 711-715 ◽  
Author(s):  
R. Kumar ◽  
Kay Robson
Keyword(s):  
Mental Health ◽  
Preliminary Report ◽  
Previous History ◽  
First Trimester ◽  
Induced Abortion ◽  
Depression And Anxiety ◽  
History Of ◽  
Expectant Mothers ◽  
Clinically Significant ◽  
In Pregnancy

SynopsisOne hundred and nineteen primiparae, who were routinely attending ante-natal clinics, were interviewed repeatedly between the 12th and 36th weeks of their pregnancies. The incidence of depression was highest in the first trimester and, overall, about a fifth of the sample was found to be suffering from clinically significant neurotic disturbances. In a proportion of these expectant mothers there was an association between depression and anxiety early in pregnancy and a previous history of induced abortion; this phenomenon may reflect a reactivation of mourning which was previously suppressed.

scholarly journals Ectopic pregnancy in a tertiary care centre of Jharkhand, India

2019 ◽  
Vol 8 (8) ◽  
pp. 2969
Author(s):  
Meetali Parashar ◽  
Meena Mehta
Keyword(s):  
Ectopic Pregnancy ◽  
Clinical Presentation ◽  
Previous History ◽  
First Trimester ◽  
Near Miss ◽  
Obstetrics And Gynaecology ◽  
Maternal Morbidity And Mortality ◽  
History Of ◽  
Β Hcg ◽  
A Prospective Study

Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions:Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.

Adherence rates and outcomes for 17-hydroxyprogesterone caproate use in women with a previous history of preterm birth

2020 ◽  
Vol 2 (3) ◽  
pp. 100166
Author(s):  
Alexandra M. Edwards ◽  
Sarah A. Lowry ◽  
Sam Mikovich ◽  
Alicia B. Forinash ◽  
Shilpa Babbar
Keyword(s):  
Preterm Birth ◽  
Previous History ◽  
Hydroxyprogesterone Caproate ◽  
History Of ◽  
17 Hydroxyprogesterone

scholarly journals A study on risk factors, maternal and foetal outcome in cases of preeclampsia and eclampsia at a tertiary care hospital of South India

2017 ◽  
Vol 7 (1) ◽  
pp. 266
Author(s):  
Bandaru Sailaja ◽  
Vijayalakshmi Cooly ◽  
Bhuvaneswari Sailcheemala ◽  
Surayapalem Sailaja
Keyword(s):  
Risk Factors ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Previous History ◽  
Developed Countries ◽  
Reproductive Technologies ◽  
Care Hospital ◽  
History Of ◽  
Foetal Outcome ◽  
In Pregnancy

Background: Hypertension in pregnancy remains still a major health issue for women and their descendants throughout the world but remains a major issue in developing countries rather than developed countries. Eclampsia accounts for 24% of maternal deaths during pregnancy in India according to FOGSI study in India. Changing trends in pregnancy globally with increased maternal age of conception, assisted reproductive technologies has contributed a significant impact in the risk factors for PE and eclampsia. The present study was aimed to investigate and determine the related risk factors in cases of PE and eclampsia. The maternal and foetal outcomes with major complications of the women with PE and eclampsia were also studied.Methods: A prospective cross sectional study for a period of two years was conducted at a tertiary care hospital among antenatal cases and all cases of PIH were recorded and studied. Cases were managed as per the existing obstetric protocol after clinical examination and investigations. Detailed socio demographic data and history of risk factors were collected and entered into Microsoft excel sheet and analyzed. Maternal and foetal outcome were noted in the cases of the study.Results: The incidence of PE and eclampsia in the study was 43.3% and 10.8%, 25-35 years age group being the most common. PE and eclampsia was associated with BMI>30, parous women with previous history of PE, diabetes mellitus and more in unregistered cases. PE and eclampsia were more in Illiterates and socio economic class 2 &3. The incidence of maternal complications was 32.99% with premature labour being the common and in case of foetal complications prematurity was the commonest with 16 cases. The maternal mortality was very less with only 4.64% in the study.Conclusions: Pregnancy induced hypertension with PE and eclampsia still remains a major problem in developed countries. Good antenatal care with increased awareness and increased antenatal visits may help in reducing the incidence and maternal and foetal complications. Increased incidence among illiterates and low socio economic status group provides the target group to be directed against any medical measures and national health programmes.

scholarly journals Premature Birth, Management, Complications

2021 ◽  
Author(s):  
Panagiotis Tsikouras ◽  
Anastasia Bothou ◽  
Aggeliki Gerede ◽  
Ifigenia Apostolou ◽  
Fotini Gaitatzi ◽  
...  
Keyword(s):  
Premature Birth ◽  
Previous History ◽  
Premature Births ◽  
Nucleotide Polymorphisms ◽  
Mortality And Morbidity ◽  
Genes And Environment ◽  
Treatment Administration ◽  
History Of ◽  
Ultrasound Assessment ◽  
Successful Prevention

In recent years an increase in premature births (PB) rate has been noticed, as this pregnancy complication that still remain an important cause of perinatal morbidity and mortality, is multifactorial and prediction is not easy in many cases. There are many bibliographic data supporting the view that PB have also genetic predisposition. The trend of “recurrence” of PB in women as well as its increased frequency in ethnic groups suggests its association with genetic factors, either as such or as an interaction of genes and environment. Immunomodulatory molecules and receptors as well as polymorphisms of various genes and/or single nucleotides (single nucleotide polymorphisms, SNPs) now allow with advanced methods of Molecular Biology the identification of genes and proteins involved in the pathophysiology of PB. From the history of a pregnant woman, the main prognostic factor is a previous history of prematurity, while an ultrasound assessment of the cervix between 18 and 24 weeks is suggested, both in the developed and the developing world. According to the latest data, an effective method of successful prevention of premature birth has not been found. The main interventions suggested for the prevention of premature birth are the cervical cerclage, the use of cervical pessary, the use of progesterone orally, subcutaneously or transvaginally, and for treatment administration of tocolytic medication as an attempt to inhibit childbirth for at least 48 hours to make corticosteroids more effective. Despite the positive results in reducing mortality and morbidity of premature infants, the need for more research in the field of prevention, investigation of the genital code and the mechanism of initiation of preterm birth is important.

scholarly journals DETECTION OF HYPOTHYROIDISM IN EARLY PREGNANCY: UNIVERSAL SCREENING

2020 ◽  
pp. 1-4
Author(s):  
Manpreet Kour ◽  
Taranjeet Kour
Keyword(s):  
Pregnant Women ◽  
Previous History ◽  
First Trimester ◽  
Normal Serum ◽  
Systemic Review ◽  
Overt Hypothyroidism ◽  
Endocrine Disorders ◽  
History Of ◽  
Adverse Pregnancy ◽  
Hypothyroid Patients

Background: Thyroid dysfunction is one of the most common endocrine disorders in women of childbearing (1), second only to diabetes mellitus.The aim of this systemic review was to determine whether an increased maternal TSH level and normal serum T4 levels, as seen in SCH, could also be associated with pregnancy complications. Methods: This study was conducted in Nobel hospital,Pune January 2015 to July 2016 in all the pregnant women attending antenatal clinic in their first trimester of pregnancy. Data was collected on a pre-designed, pre-tested study proforma which includes socio-demographic information of patients, detailed clinical history and examinations of pregnant women and babies. Blood samples were taken under all aseptic precautions and were sent to laboratory of the institute for routine investigations and thyroid profile. Patients were followed up till delivery and babies were followed up till discharge from the hospital. Results:This study was conducted in 220 patients in obstetrics and gynaecology department in Noble Hospital, Pune. Out of 220 cases,198 cases were euthyroid, 13 cases were subclinical hypothyroid and 9 cases were overt hypothyroid. Hypothyroidism was found in 22(10%) of pregnant women in their first trimester. Out of which, 13(5.91%) had subclinical hypothyroidism and 9(4.09%) had overt hypothyroidism. Majority of the patients 45.45% were in age group of 26-30years. 90.91% of hypothyroid patients had regular cycles and 9.09% had irregular cycles. Hypothyroidism was equally distributed between primi and multigravida patients. 31.82% of hypothyroid patients had previous history of abortions and 68.18% had no such history.18.18% of hypothyroid patients had history of infertility and 31.82% had no history of infertility. Anti-TPO was present in 9.09% and none of euthyroid patients. Maternal and Fetal complications were found more in hypothyroid patients than euthyroid patients. Conclusion: Most of the patients in our study who have subclinical thyroid disease are asymptomatic, so screening is the most convenient method to identify such patients. Follow-up of abnormal TSH values with FT3 and FT4 may yield valuable results which could enable us for therapeutic intervention and may go a long way in preventing adverse pregnancy outcomes.

scholarly journals Meta-analysis and randomized controlled studies: what clinicists should know to prevent regular and spontaneous miscarriages of unexplained genesis?

2021 ◽  
pp. 39-44
Author(s):  
Paul Piette
Keyword(s):  
Early Pregnancy ◽  
Recurrent Miscarriage ◽  
Meta Analysis ◽  
First Trimester ◽  
Recommended Treatment ◽  
Randomized Controlled Studies ◽  
History Of ◽  
Threatened Abortion ◽  
The Moment ◽  
Micronized Progesterone

The etiopathology of recurrent miscarriage is a combination of various factors, including chromosomal defects, genetic or structural abnormalities, endocrine abnormalities, infections, immune dysfunction, thrombophilia disorders, antiphospholipid syndrome, and unexplained causes.It has long been known that progesterone is needed to maintain pregnancy and its physiological development. Insufficient progesterone secretion and its low level in the blood serum in early pregnancy is associated with the threat of miscarriage and loss of pregnancy at a later stage – up to 16 weeks of gestation. The effectiveness of the vaginal micronized progesterone (VMP) at a dose of 400 mg twice a day in the first trimester of pregnancy was evaluated in two recent large high-quality multicenter placebo-controlled studies, one of which included pregnant women with recurrent miscarriages of unexplained origin (PROMISE Trial), and the other study included women with early pregnancy loss (PRISM Trial). A key finding, pioneered in the PROMISE study and later confirmed in the PRISM study, was that VMP treatment associated with an increase in live births in line with the number of previous miscarriages. It has been shown that there is no evidence regarding safety concerns with natural micronized progesterone. Treatment with an VMP should be recommended for women with bleeding in early pregnancy and a history of one or more miscarriages. The recommended treatment regimen is 400 mg 2 times a day (800 mg/day) intravaginal, starting from the moment bleeding is detected up to 16 weeks of pregnancy.In the future, there remains uncertainty effectiveness and safety of alternative progestogens (dydrogesterone) for the treatment of women at high risk of threatened abortion and recurrent miscarriage. It is important that dydrogesterone is a synthetic progestin, its structure is significantly different from natural progesterone, and therefore it is necessary to unequivocally prove the short- and long-term safety of this drug before considering its use in clinical practice.

scholarly journals Guillain Barre Syndrome pada Kehamilan

2020 ◽  
Vol 9 (2) ◽  
pp. 256
Author(s):  
Hermin Sabaruddin ◽  
Pribakti Budinurdjaja ◽  
Fakhrurrazy Fakhrurrazy
Keyword(s):  
Physical Examination ◽  
First Trimester ◽  
Clinical Syndrome ◽  
Guillain Barre Syndrome ◽  
High Morbidity ◽  
Autoimmune Reaction ◽  
Guillain Barré Syndrome ◽  
History Of ◽  
Guillain Barré ◽  
In Pregnancy

Guillain-Barre Syndrome (GBS) is a clinical syndrome characterized by the presence of the complete flaksid that occurs in acute. GBS associated with autoimmune reaction that affect peripheral nerve, radix, and cranial nerve. The incidence of GBS is 1 – 2 per 100,000 people/year. The incident was followed by increased age and the increasing population of obstetrics. GBS in pregnancy ranged from 13% in the first trimester, 47% in the second trimester, and 40% in the third trimester. In this case report reported Mrs. M 27 years old with a diagnosis of G2P1A0 h. 39-40 weeks + insimanation + living single fetal Presentation Head + Inpartu kala II + GBS + Failed + Vacuum Severily Underweight (BMI = 17) + TBJ 3000 Gr. Diagnosis of GBS are enforced based on anamnesis, physical examination and complementary examinations. From a previous illness history found anamnesis the weakness of limbs beginning in 2016. A history of the use of breathing apparatus and admitted tot the ICU in the first pregnancy. Mrs. M had a history of infections before being diagnosed with GBS. On this second pregnancy patients cannot move lower extremity but upper extermity is still functioning. Physical examination result of mothers and babies in the normal range even though found in conditions of severily BMI underweight. The patient finally decided to SC (section caesaria) and applied the IUD intracaesarean GBS in pregnancy is a coincidental. GBS is rarely aggravate pregnancy, but if not quickly identified and handled can enhance the high morbidity in both mother and fetus. In acute attacks (AIDP) in pregnant women with GBS increase stress on the mother or the fetus. The stress that occurs can also stimulate the immune system to produce prostaglandins, resulting in premature birth. Patients can give birth when the gestational age is still 7 months. It was different in the second pregnancy in this case where the patient was diagnosed with chronic inflammatory demyelinating polyradiculopathy (CIDP) so that GBS did not affect the mother and the fetus.

scholarly journals Faktor-faktor yang berhubungan dengan hipertensi pada ibu hamil

2021 ◽  
Vol 14 (4) ◽  
pp. 642-650
Author(s):  
Syamraini Silda ◽  
Ana Mariza ◽  
Sunarsih Sunarsih
Keyword(s):  
Pregnant Women ◽  
Health Centre ◽  
Previous History ◽  
Cross Sectional ◽  
Public Health Centre ◽  
Hypertension In Pregnancy ◽  
Hypertensive Disorders ◽  
Risk Parity ◽  
History Of ◽  
In Pregnancy

Factors for hypertensive disorders of pregnancy among mothers in Lampung, IndonesiaBackground: Hypertension in pregnancy when blood pressure reaching 140/90 mmHg or more, which occurs during pregnancy. Hypertension in pregnancy can cause mortality and the number of prevalent still too high.Purpose: To know the factors associated with hypertension among pregnant women Inpatient public health centre, South Lampung.Method: A quantitative study with a cross-sectional with a prospective approach. The sampling was all pregnant women who follow up at the health center of 80 respondent on May 20 - July 24, 2019 taken by accidental sampling and data collected using observational sheets and interviews. Data analysis using chi-square test to find correlation among variables.Results: Shows that of 80 respondents who suffering of hypertension of 45%, age its risky category of  57.5%, parity its risky category, has obesity of 42.5% and having a history of hypertension in those without a previous history of hypertension of 35%. Statistical test results show that age its risk with p = 0.029, parity its risk (p = 0,000), obesity (p = 0.000) and a history of hypertension (p = 0.000). conclusion that there was a relationship between age its risk, parity its risk, obesity, and hypertension history with the incidence of hypertensionKeywords: Hypertensive disorders; Pregnancy; An age of risk; A parity of risk; Obesity; History of hypertensionPendahuluan:Hipertensi dalam kehamilan adalah tekanan darah mencapai 140/90  mmHg atau lebih yang terjadi saat kehamilan. Hipertensi pada kehamilan dapat menyebabkan mortalitas pada ibu hamil dan angkanya masih cukup relatif tinggi.Tujuan: Diketahui faktor-faktor yang berhubungan dengan hipertensi pada ibu hamil di wilayah kerja UPT Puskesmas Rawat Inap Katibung Lampung Selatan.Metode : Penelitian kuantitatif dengan pendekatan desain cross sectional study pendekatan prospektif. Teknik pengambilan sampel yang dilakukan adalah Accidental sampling. Sampel dalam penelitian ini adalah seluruh ibu hamil yang datang ke Puskesmas selama penelitian berlangsung yaitu sebanyak 80 ibu hamil pada tanggal 20 Mei – 24 Juli 2019 . Pengumpulan data diperoleh menggunakan lembar observasional dan wawancara. Analisis hubungan menggunakan uji chi-square.Hasil: Menunjukkan bahwa dari 80 ibu hamil yang mengalami hipertensi sebanyak 36 orang (%) sedangkan yang tidak hipertensi sebanyak 44 orang (%).Umur terbanyak pada yang beresiko 46 orang (57,5%) , Paritas pada yang tidak beresiko sebanyak 43 orang (53,75%) , Obesitas yang terbanyak pada yang tidak obesitas 46 orang (57,5%) dan Riwayat hipertensi sebelumnya terbanyak pada yang tidak ada riwayat hipertensi sebelumnya sebanyak 52 orang (65%).Hasil uji statistik bivariate menunjukkan bahwa umur (p=0,029) , paritas (p=0,000) , obesitas (p=0.000) dan  riwayat hipertensi (p=0.000) sehingga disimpulkan umur, paritas, obesitas dan riwayat hipertensi berhubungan dengan kejadian hipertensi pada ibu hamil.

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