Pathogenetic approach of preterm labour treatment in the background of chronic infection source

2017 ◽  
pp. 54-58
Author(s):  
S.N. Heryak ◽  
◽  
N.V. Petrenko ◽  
V.Yu. Dobryanskа ◽  
O.A. Yakimchuk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Premature Birth ◽  
Conventional Therapy ◽  
Preterm Labor ◽  
Pain Syndrome ◽  
Control Group ◽  
Channel Blockers ◽  
Treatment And Prevention ◽  
Micronized Progesterone

The objective was to study the effectiveness of the application of the sublingual form of micronized progesterone for the treatment and prevention of premature birth in women with concomitant risk factors against the background of the infectious inflammatory component in the anamnesis. Materials and methods. The study was conducted in two stages. At the first stage, 100 stories of pregnant women with preterm labor were analyzed at a period of 22-36 weeks, which were inpatient treatment in the Ternopil Regional Clinical Perinatal Center «Mother and Child». A comprehensive assessment of risk factors for the development of preterm labor and the effectiveness of their management was carried out. At the second stage of the study, 27 pregnant women (group 1) who were hospitalized with a threat of premature birth and had an anamnesis history, were treated with natural micronized progesterone Lutein in a dose of 100 mg sublingually twice a day. The comparison group (group 2) included 30 pregnant women, who before traditional hospitalization began traditional tocolytic therapy with calcium channel blockers. The control group included 20 pregnant women with a physiological pregnancy. Results. As a result of the proposed therapy, a decrease in the intensity of the pain syndrome in patients taking micronized progesterone was observed at 25 min faster (p <0.05) than after conventional therapy (85.2 ± 7.4 min in the 1st group and 110.6 ± 9.8 min - in the second group). At the same time, anxiety level was 16.1 ± 1.8 points in patients of the 1st group, which corresponded to its absence, while the patients of the 2nd group continued to be in a state of moderate anxiety (19.3 ± 1.4 points). Pregnant women with a threat of preterm birth who had an inflammatory process of any localization in the past had a significant increase in the level of proinflammatory cytokines (IL-2, IL-6, TNF-?) and a decrease in the level of anti-inflammatory cytokines (IL-4, IL- 10) in comparison with the indicators of healthy pregnant women. The use of micronized progesterone and conventional therapy positively affects these indicators. Conclusion. The use of the sublingual form of micronized progesterone in the preparation of Lutein at a dose of 200 mg per day is pathogenetically grounded and provides a rapid arrest of the manifestations of premature birth in women with miscarriage in the background of chronic foci of infection. Key words: premature birth, inflammation, micronized progesterone.

scholarly journals Risk Factors for premature birth in a hospital

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Margarita E. Ahumada-Barrios ◽  
German F. Alvarado
Keyword(s):  
Risk Factors ◽  
Prenatal Care ◽  
Pregnant Women ◽  
Premature Birth ◽  
Bivariate Analysis ◽  
Control Group ◽  
Case Group ◽  
Retrospective Case ◽  
History Of ◽  
Inadequate Prenatal Care

Abstract Objective: to determine the risk factors for premature birth. Methods: retrospective case-control study of 600 pregnant women assisted in a hospital, with 298 pregnant women in the case group (who gave birth prematurely <37 weeks) and 302 pregnant women who gave birth to a full-term newborn in the control group. Stata software version 12.2 was used. The Chi-square test was used in bivariate analysis and logistic regression was used in multivariate analysis, from which Odds Ratios (OR) and Confidence Intervals (CI) of 95% were derived. Results: risk factors associated with premature birth were current twin pregnancy (adjusted OR= 2.4; p= 0.02), inadequate prenatal care (< 6 controls) (adjusted OR= 3.2; p <0.001), absent prenatal care (adjusted OR= 3.0; p <0.001), history of premature birth (adjusted OR= 3.7; p <0.001) and preeclampsia (adjusted OR= 1.9; p= 0.005). Conclusion: history of premature birth, preeclampsia, not receiving prenatal care and receiving inadequate prenatal care were risk factors for premature birth.

Prospects of the treatment of preterm labor by the use of sublingual forms of micronized progesterone

2016 ◽  
pp. 28-32
Author(s):  
G.I. Reznichenko ◽  
◽  
N.Yu. Reznichenko ◽  
V.Yu. Potebnya ◽  
I.L. Antonyuk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Preterm Labor ◽  
Total Bilirubin ◽  
Antenatal Clinic ◽  
Premature Births ◽  
Complex Treatment ◽  
Delayed Treatment ◽  
Threatened Preterm Labor ◽  
Micronized Progesterone

The objective: to determine the efficacy of sublingual forms of micronized progesterone (Luteina) in treatment of women with preterm labor. Patients and methods. 45 women with preterm labor were examined in 24–35 weeks of gestation. 2 subgroups were formed. Subgroup Ia consisted of 23 women, who received micronized progesterone sublingually in complex treatment, subgroup IB consisted of 22 pregnant women, who didn’t receive progesterone. 56 case reports of premature births were analyzed retrospectively. The main group of pregnant women underwent general and biochemical examination, determination of ALT, AST, total bilirubin and progesterone. Results. Risk factors for preterm labor during observation in the antenatal clinic were established. They included the underestimation of anamnesis, incomplete examination, delayed treatment of threatened preterm labor, insufficient prevention of complications of pregnancy. It was established that the levels of both AST and ALT as well as total bilirubin in serum hadn’t change after the treatment in both subgroups of women from I group. The decrease in the serum level of progesterone was observed in both subgroups. Average concentration of progesterone in blood serum increased up to 1108±39 nmol/l on the third day of treatment in the subgroup Ia, and it reached 1260±42 nmol/l on the seventh day, whereas its dynamics practically didn’t chang in subgroup IB (882±33 nmol/l and 893±31 respectively). The use of sublingual form of micronized progesterone in the complex treatment of women with preterm labor gave the opportunity 2 times to decrease frequency of premature births, 1.5 times to decrease frequency of delivery complications, almost 2.5 to improve perinatal consequences compared to subgroup of women who hadn’t use progesterone. Conclusions. 1. Risk factors of preterm labor are delayed first prenatal visit of pregnant women to antenatal clinic, the underestimation of anamnesis and risk factors for the development of gestational complications, incomplete examination, delayed treatment of threatened preterm labor, incomplete prevention of pregnancy complications. 2. The use of sublingual forms of micronized progesterone in cases of signs of preterm labor permits to restore quickly the level of progesterone in blood serum to physiological parameters, 2 times to decrease the frequency of premature births and 2.5 times to decrease perinatal consequences in infants. 3. The use of sublingual form of micronized progesterone in pregnant women with preterm labor does not affect the function of the liver. 4. The obtained results allow to recommend the wide use of sublingval form of micronized progesterone to pregnant women with preterm labor. Key words: preterm labor, treatment, Luteina.

scholarly journals CERVICAL INSUFFICIENCY: ANAMNESIS, PREGNANCY AND CONSEQUENCES OF PREGNANCY (RETROSPECTIVE ANALYSIS)

2021 ◽  
pp. 30-38
Author(s):  
A. V. KAMINSKYI ◽  
O. I. ZHDANOVYCH ◽  
T. V. KOLOMIICHENKO ◽  
R. I. ISMAILOV ◽  
S. M. YANUTA
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Retrospective Analysis ◽  
High Frequency ◽  
Premature Birth ◽  
Uterine Cavity ◽  
Lower Percentage ◽  
Control Group ◽  
Cervical Canal ◽  
Cervical Insufficiency

Cervical insufficiency (CI) remains one of the leading causes of miscarriage and premature birth. Purpose of the study: to determine the frequency of CI, the characteristics of the anamnesis, the course of pregnancy, childbirth, the state of the newborn and the identification of potential risk factors. Material and research methods. 8728 birth histories were analyzed, among which 166 (1.9%) stories of women whose pregnancy was complicated by CI were found. The main group consisted of 166 pregnant women with CI, the control group included 55 women without CI and other severe obstetric- gynecological and somatic pathologies. The results obtained and their discussion. The incidence of CI on average over 5 years was 1.9%. With CI, there is a significantly lower percentage of young women, and at the age of 35 and over - 27.1% of pregnant women versus 10.9% in the control group. Only one third (33.7%) of women with CI can be considered somatically healthy. The morbidity structure is dominated by endocrine pathology (30.7%), among which metabolic syndrome / obesity (19.9%) and diseases of the urinary excretory system (27.7%) are distinguished. High frequency of pathology of the cardiovascular system (21.1%) and autonomic dysfunction syndrome (25.9%), hepatobiliary pathology (15.1%), gastrointestinal diseases (19.3), allergic manifestations (16.9%). A third of patients (28.9%) have a combination of two or more somatic diseases. Every fourth woman has a history of an infectious pathology of the urinary excretory sphere (25.9). In 27.7% of patients - a combination of several infectious pathologies. Half of the patients (53.0%) had a complicated gynecological history: cervical ectopy (33.7%), chronic infectious diseases of the genital area (16.3%) and PCOS: (13.9%), synechiae of the uterine cavity (6.6 %) and congenital malformations of the genitals (3.0%). The combination of several gynecological pathologies was observed in 18.1% of women. Every fourth woman underwent an excision of the cervix (25.9%), 42.8% - intrauterine interventions with the expansion of the cervical canal, 59.2% of them two or more times. According to the obstetric anamnesis, spontaneous miscarriages and medical abortions in 27.7% and 33.7% of women, in 18.1% - a missed pregnancy, every fourth patient has premature birth (25.9%), and every 10th patient has suffered injuries cervix. With a current pregnancy, the threat of premature birth is most often noted (51.2%), in second place is an exacerbation of infection of the genitourinary sphere (41.0%) and the threat of premature birth (38.0%). High incidence of placental dysfunction (30.7%), gestational diabetes (13.9%), fetal growth retardation (12.0%) and preeclampsia (7.3%). Premature birth in 38.0% of cases, in 31.9% - premature rupture of membranes, delivery by cesarean section in 19.3% of cases. Noteworthy is the high frequency of intrauterine infection (13.9%). Conclusion. Based on the results of a retrospective analysis, after a more detailed assessment of possible risk factors for CI, the most informative ones will be identified and proposed for use in clinical practice.

Risk factors of early preterm labor in single-pregnant women after assisted reproductive technologies

2018 ◽  
pp. 128-131
Author(s):  
A.S. Mandrykova ◽  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Preterm Labor ◽  
Assisted Reproductive Technologies ◽  
Fertility Restoration ◽  
Reproductive Technologies ◽  
Control Group ◽  
Premature Rupture ◽  
Group I ◽  
Prophylactic Measures

The objective: determination of risk factors of early preterm labor in single-pregnant women after ART on the basis of clinical and anamnestic data. Materials and methods. We study of 130 single-pregnancy pregnancies among the contingent of women with restored fertility after the use of therapeutic ART programs, which ended with early preterm labor. Group I consisted of 50 pregnant women with premature rupture of the membranes for which the tactics of pregnancy with were born by natural way. The second group consisted of 30 pregnant women with premature rupture of the membranes, who carried out general medical and prophylactic measures in accordance with the clinical protocols in accordance with the orders of the Ministry of Health of Ukraine. The control group (GC) has formed 50 pregnant women with early preterm labor with unbroken integrity of the membranes. Results. The retrospective analysis of the methods of fertility restoration in women who were included in the study, carried out by us, indicates the probable relationship of risk of early preterm labor with the ICSI method. The obtained data testify that pregnancy 42.5% of women of the main group, who was chosen ICSI technique ended with early preterm labor. In the contingent of patients whose pregnancy came with IVF, the percentage early preterm labor was 37.5 (р<0.05). The obtained results of researches testify to increase of risks early preterm labor (22.1–29.7%) in patients with chronic inflammatory diseases of the urinary system, which had a latent course. Conclusions. Among the reliable factors of early preterm labor risk, it is necessary to note the high frequency of intrauterine manipulations of diagnostic and therapeutic nature in the use of ART, which results in receptor dysfunction of the endometrium. Key words: risk factors of early preterm labor, assistive reproductive technologies, ICSI, IVF, premature rupture of the membranes, dysfunction of the endometrium.

scholarly journals Evaluation of the effectiveness of the appointment of acetylsalicylic acid for the prevention of obstetric complications by the method of logistic regression

2021 ◽  
Vol 5 ◽  
pp. 19-27
Author(s):  
V.О. Herasymchuk ◽  
O.S. Zahorodnia ◽  
D.Yu. Krukovets
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Acetylsalicylic Acid ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Premature Birth ◽  
Reproductive Technologies ◽  
Negative Sign ◽  
Control Group ◽  
Second Trimester

Preeclampsia remains to be an urgent problem in the modern medicine, the main reason for which is the lack of high efficiency of treatment. One of the few methods with proven effectiveness is the prophylactic administration of aspirin at the beginning of the second trimester of pregnancy. At the same time, microcirculation disorders that underlie the development of preeclampsia are pathogenetically significant for other gestational complications.The objective: a study of the effectiveness of aspirin prescription for the prevention of preeclampsia and other complications during pregnancy using the logistic regression method.Materials and methods. The control group included 43 pregnant women with clinical criteria for preeclampsia. Forty six pregnant women with risk factors for preeclampsia who took acetylsalicylic acid from the 16-18 weeks of gestation formed the I group, and 46 pregnant women with risk factors for preeclampsia who did not take acetylsalicylic acid were included in the the II group. In all patients, on the basis of anamnesis data, risk factors and the course of the second trimester of pregnancy were analyzed, their correlation analysis and the use of acetylsalicylic acid were carried out, logistic regressions and simple decision trees were constructed.Results. The proposed logistic regression models have demonstrated their veracity by confirming the influence of traditional risk factors for the development of preeclampsia. At the same time, the use of these models allowed not only to prove the preventive effect of aspirin on the development of preeclampsia (the coefficient is statistically significant, with a negative sign), but also the ability to reduce the severity of preeclampsia. In addition, the negative sign of the coefficient was obtained when studying the effect of taking aspirin on such complications of pregnancy as premature birth and fetal growth retardation.Conclusions. 1. The use of a database of patients, statistical and model analysis of this dataset, allows you to establish and evaluate the relationship, their statistical significance between different factors. Based on the results of the research we can say with great confidence about the significant effect of prophylactic aspirin intake on reducing the risk of preeclampsia. 2. Taking aspirin reduces the likelihood of fetal growth retardation and premature birth. 3. The use of assisted reproductive technologies is positively correlated with the risk of developing preeclampsia. The influence of other traditional factors on the development of preeclampsia was proved by the method of logistic regression, which confirms the veracity of the proposed statistical model.

scholarly journals CURRENT OPPORTUNITIES FOR DETERMINING OF PREDICTORS OF THREATENED PRETERM LABOR

2019 ◽  
pp. 160-164
Author(s):  
Yu. Ya. Krut ◽  
A. A. Shevchenko ◽  
V. G. Syusyuka
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Regression Analysis ◽  
Pregnant Women ◽  
Body Mass ◽  
Premature Birth ◽  
Odds Ratio ◽  
Preterm Labor ◽  
Insulin Level ◽  
Independent Risk Factors

The aim of the study – to ascertain predictors of a threat of premature birth. Materials and Methods. 63 patients participated in the gestation period of 22–34 weeks in a prospective open study. Pregnant women were divided into two groups. Thus, the group I included 44 pregnant women, with the threat of PL, and the group II included 19 patients with normal course of pregnancy. All women were tested for body mass index (BMI), progesterone, insulin and cortisol on the day of admission. Statistical processing of materials was carried out by using the software package "Statistica 6.0" (StatSoft, USA) and MedCalc. 10.2.0.0. To determine the predictors of the occurrence of a TPL, the method of binary logistic regression analysis was used. All statistical tests were two-sided; the p-0.05 level was considered as significant. Results and Discussion. An analysis of the results of the observation of 63 pregnant women was provided. In 12 women, pregnancy ended in preterm labor, which was 19 % of the total. The following indicators fell to the dependent predictors of TPL occurrence: body mass index (BMI) ≤ 24 kg/m² significantly increased the odds ratio (OR) of TPL 7.76 times; insulin level <8.65 µMU/ml significantly increased ORR of TPL 5.14 times; OR of TPL increases in 7.02 times, in case that the level of cortisol is less than 577.9 ng/ml; progesterone <139.5 ng/ml increases the odds ratio of TPL in 4.39 times. Taking into account the data of univariate regression analysis, multivariate models of independent predictors of TPL were created. According to the first model (p = 0.0001), independent risk factors for miscarriage include: the age of pregnant women over 25 years, an insulin level more than 8.7 μMO/ml, and the level of cortisol less than 577.9ng/ml. According to the second model (p <0.0001), independent risk factors which increase the risk of TPL occurrence are: BMI less than 24 kg/m2, insulin level more than 8.7 μMO/ml, cortisol level less than 577.9ng / ml. However, the most interesting is the third model (p <0.0001) of independent risk factors for TPL. It includes four indicators: the level of progesterone, less than 139.5 ng/ml, the level of cortisol, less than 577.9 ng/ml, the BMI, less than 24 kg/m2 and the age of pregnant, more than 25 years. Conclusions. It was found that in pregnant women with a threat of preterm birth the age and BMI are the most informative, and in combination with the hormonal examination of women are of primary importance. The obtained results indicate the expedien­cy of inclusion to the standard examination of pregnant women with a threat of premature birth, a comprehensive determination of the level of progesterone, insulin and cortisol, which will enable to identify the risk group for this complication in time and to propose preventive measures.

Clinical and microbiological aspects of vaginal microbiota at pregnant with threat of late miscarriages during treatment with vaginal gestagens forms

2017 ◽  
pp. 68-73
Author(s):  
I.P. Polishchuk ◽  
Keyword(s):  
Pregnant Women ◽  
Therapeutic Effect ◽  
Local Treatment ◽  
Vaginal Microbiota ◽  
Control Group ◽  
Before And After ◽  
Low Efficiency ◽  
Late Miscarriage ◽  
Microbiological Aspects ◽  
Micronized Progesterone

The objective: was to examine the effectiveness of treatment of late miscarriage threat by micronized form of progesterone for 100 mg – 3 times a day in the form of gelatin pills and vaginal tablets with lactose. Patients and methods. Under our supervision there were 70 pregnant women with normocenosis of vagina (NCV) without extragenital pathology, which were not performed systemic or local treatment with antibacterial drugs in the last 4 weeks. Among them 25 pregnant women with TLSM treated by gelatin tablets of micronized progesterone (GTP) (group 1); 25 pregnant women with TLSM, treated by vaginal micronized progesterone tablets (VPT) (2nd group) and 20 healthy women with physiological pregnancy – PV (control group). The distribution of women in the group adhered to the principles of randomization. The age of examined women ranged from 19 to 32 years, most pregnant women were aged under 30 years (89.02%). General clinical examination was carried out according to the standard scheme according to the Order MH of Ukraine № 620. Results. During the research we have determined the colpocytologcal dynamics and state of vaginal microbiota in pregnant women with threatened late miscarriage with initial vaginal normocenosis before and after treatment whit vaginal forms of progesterone. Conclusion. The received results showed low efficiency of micronized progesterone gelatin dragee at threat of the late miscarriage that at small therapeutic effect has led to the development of vaginal dysbiosis in all surveyed. In contrast, the use of micronized progesterone vaginal tablets – the maximally rapid therapeutic effect without disturbance of vaginal normocenosis. Key words: the threat of a late miscarriage, vaginal micronized forms of progesterone.

scholarly journals The Predictive Value of the Mother’s Risk Factors in Formation of Fetal Developmental Delay

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199914
Author(s):  
Maka Chigladze
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Predictive Value ◽  
Negative Impact ◽  
Deficiency Anemia ◽  
Control Group ◽  
Case Group ◽  
Retrospective Case ◽  
Standards Of Living ◽  
Poor Nutrition

The research aimed at studying the mother’s social-hygienic and medical biological risk factors and determining their predictive value. The retrospective case-control study was conducted with 142 pregnant women participating in it. In the case group there were involved 92 mothers whose pregnancy was completed by the birth of a newborn baby suffering from the intrauterine growth restriction. The control group was made of 50 pregnant women, whose pregnancy was completed by the birth of a healthy neonate. The research resulted in specifying the risk factors of high priority: the low standards of living (OR 3.61), chronic stress (OR-3.06), sleeping disorder (OR-3.33) and poor nutrition (OR-3.81). As regards the coexisting pathology the following was revealed: endocrine pathology (OR-3.27), ischemic heart disease (OR-4.35), arterial hypertension (OR-6.47), iron deficiency anemia (OR-4.11), pathology of respiratory system (OR-3.42), chronic genital inflammatory and infectious processes. The preeclampsia (92%) and low amniotic fluid (89%) were detected to have the high predictive value. The awareness of risk factors allows us to employ the timely measures for the reduction of negative impact on the fetus and neonate.

scholarly journals THE EFFECT OF RECTAL PROGESTERONE ON DOPPLER PARAMETERS OF THE UTERINE ARTERIES FOR THE PREVENTION OF PRETERM DELIVERY IN IRAQI POPULATION

2018 ◽  
Vol 11 (10) ◽  
pp. 545
Author(s):  
Fatin Shallal Farhan ◽  
Ban Hadi Hameed ◽  
Muna Abdulghani Zghair
Keyword(s):  
Pregnant Women ◽  
Preterm Labor ◽  
Resistance Index ◽  
Control Group ◽  
Study Group ◽  
Duration Of Treatment ◽  
Uterine Arteries ◽  
Doppler Study ◽  
Threatened Preterm Labor ◽  
Doppler Indices

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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