Efficient and secure opportunities for overcoming the threat of woman miscarriage risk pregnancies
The objective. To assess the clinical efficacy and safety of micronized progesterone in the treatment of threatened abortion in the early stages. Patients and methods. Studied 80 women of reproductive age with the threat of termination of pregnancy in the early stages of seeking medical help at the Research Institute "of Maternity and Child" Health Ministry of Yekaterinburg in the period from November 2013 to May 2014. The patients were divided into two groups of 40 people, depending on the use or nonhormonal support micronized progesterone. In terms of average age and gestational age at study entry, as well as parity groups were not statistically different (p > 0,05). Age of the main group of women ranged from 19 to 41 years (31.3 ± 0.8). Age of the patients in the control group was 21-44 years (32.5 ± 0.5). Gestational age at enrollment in the study group was 3-13 weeks (8.7 ± 0.4) in the control group at 5-15 weeks (9.0 ± 0.2). For obstetric- gynecologic history comparison groups differed on the following parameters. The main group of women often recorded endometriosis and ovarian cysts. In the control group not represented by a woman with agenesis of appendages. The comparison group (40 patients) included women who did not receive hormonal support in the complex therapy preserves threat of pregnancy. The main group (40 persons) were women, who were treated threat mikronized progesterone for three months. Micronized progesterone was administered at a dose of 300 mg during the first 2 weeks of treatment (100 mg vaginally in the morning, in the evening -200 mg vaginally). On the third week, and over the next 12 weeks - 100 mg in the morning and evening, vaginally. Therapy was administered and evaluated based on: the presence/absence of pain, the presence/absence of bleeding from the genital tract, the presence/absence retrochorial hematoma on ultrasound. Effectiveness of treatment was assessed by number of patients to carry a pregnancy over 25 weeks of gestation. Safety and tolerability of the treatment was assessed by the presence or absence of adverse events detected using diagnostic and laboratory techniques, as well as on the basis of patients' complaints, inspections and data to identify side effects. Results. of the complex retains micronized progesterone therapy, managed to preserve and prolong pregnancy more than 25 weeks gestational age 38 (95%) high-risk women with a history of obstetric and gynecological history and complicated pregnancy, in contrast to the control group where pregnancy loss amounted to 27,5% (11 people). In the main group medical abortions were before the pregnancy in 25% of cases. Infertility history was 42.5% (initial - 17,5%, 25% secondary). At 12.5%, this pregnancy is the result of IVF, 7.5% - as a result of IVF + ICSI. In 10% of the women were unsuccessful IVF attempts in history. 30% of women burdened with history of habitual miscarriage. Contingent core group of pregnant burdened congenital malformations of internal genital organs in 10%, severe endometriosis in 27.5%, uterine scar after cesarean section in 10% and after myomectomy 10%. During pregnancy, women in the study group was complicated by the presence of tumor-like formations of the uterus and appendages. Pregnancy combined with tumor-like formations of the uterus in 42.5%, with ovarian cysts in 37.5%. Threat to the outcome in CIN formed in 22.5% of women. In 100% of the women received hospital treatment in the department of gynecology, 42.5% performed surgery (12.5% tsirklyazh cervix, 17.5% cystectomy, myomectomy 7.5%, 5% fetal surgery in monochorionic double). Conclusion. This study demonstrated the efficacy and safety of vaginal administration of micronized progesterone in the treatment of threatened abortion in the early stages. Vaginal administration of progesterone in 95% of cases, reduced the risk of preterm birth and, therefore, associated neonatal complications in women with threatened miscarriage in the presence of complicated obstetric and gynecological history and complicated pregnancy, that is, a group of women at high risk. These results differ significantly from those in the group of women without hormonal support micronized progesterone, where pregnancy was prolonged in 29 (72.5%) cases (p ≤ 0,05). The findings suggest a distant improved outcomes for infants of women in this category.