RESUMEN
AIM: Preterm premature rupture of membranes (PPROM) is responsible for approximately one-third of premature births worldwide, and although the diagnosis is often straightforward, this condition can still present difficulties. The purpose of this research was to compare the accuracy of several PPROM diagnostic tests. METHODS: A total of 94 pregnant women with clinical suspicion of PPROM who were between 20 and 36 weeks of pregnancy were examined by vaginal speculum, and tests were performed for phenol, pH, insulin-like growth factor binding protein-1 (IGFBP-1) and placental alpha-microglobulin-1 (PAMG-1). All patients were followed up until the diagnosis was fully defined, and a diagnosis of PROM was confirmed by a definitive evolution of the clinical symptoms (visualization of vaginal amniotic fluid or persistence of oligohydramnios). RESULTS: After excluding the cases that could not be definitively diagnosed, a good diagnostic performance of the immunochromatographic tests was observed that was superior to that of the clinical tests. Similar accuracies were observed for IGFBP-1 (98.7%) and PAMG-1 (93.9%). However, while the IGFBP-1 test differed from a vaginal pH ≥7 (88.9%) and the phenol test (85.7%), this did not occur for the PAMG-1 test. The performance of the tests was modified only by the presence of bleeding (with lower specificity rates for pH and phenol), without interference of gestational age or maternal morbidities. CONCLUSION: Immunochromatographic tests are good tools but should be used sparingly in resource-poor settings because they are expensive, and there is no significant difference between PAMG-1 and traditional tests.
Asunto(s)
alfa-Globulinas/metabolismo , Líquido Amniótico/metabolismo , Rotura Prematura de Membranas Fetales/diagnóstico , Proteína 1 de Unión a Factor de Crecimiento Similar a la Insulina/metabolismo , Fenol/metabolismo , Vagina/química , Adulto , Técnicas de Diagnóstico Obstétrico y Ginecológico/normas , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Concentración de Iones de Hidrógeno , Inmunoensayo , EmbarazoRESUMEN
AIM: Our aim was to investigate the effect of the prophylactic use of vaginal progesterone on the latency period from the initiation of tocolytic therapy to delivery in twin pregnancies with preterm labor. METHODS: This study was a secondary analysis of a randomized, double-blind, placebo-controlled trial of twin pregnancies in mothers who were exposed to a 200 mg vaginal progesterone ovule or a placebo ovule daily from 18 to 34 weeks gestation. Patients who were administered tocolysis with Atosiban because of preterm labor were included. The latency from tocolysis to delivery, mean gestational age at delivery and the rates of delivery within 48 h and within seven days were compared between progesterone and placebo groups. RESULTS: The analysis included 27 women in the progesterone group and 30 in the placebo group. The baseline characteristics were similar between the groups. Overall, there were no differences in the latency period to delivery (17.54 ± 13.54 days and 21.58 ± 13.52 days; P = 0.289), rates of delivery within 48 h (14.8% and 6.7%; P = 0.40) or within seven days (29.64% and 23.3%; P = 0.76) or mean gestational age at delivery (32.53 ± 3.33 and 34.13 ± 2.87; P = 0.08) between the progesterone and placebo groups, respectively. CONCLUSIONS: Prophylactic use of 200 mg of vaginal progesterone does not influence the latency to delivery in women with twin pregnancies treated with tocolysis because of preterm labor.
Asunto(s)
Trabajo de Parto Prematuro/tratamiento farmacológico , Evaluación de Resultado en la Atención de Salud , Embarazo Gemelar , Progesterona/farmacología , Tocólisis/métodos , Tocolíticos/farmacología , Administración Intravaginal , Adulto , Método Doble Ciego , Femenino , Humanos , Embarazo , Progesterona/administración & dosificación , Tocolíticos/administración & dosificación , Vasotocina/administración & dosificación , Vasotocina/análogos & derivados , Vasotocina/farmacología , Adulto JovenRESUMEN
INTRODUCTION: A previous study indicated that progesterone reduces the mean uterine contraction frequency in singleton pregnancy at high risk for preterm birth. The aim of this study was to investigate the effect of vaginal progesterone on the frequency of uterine contractions in twin pregnancies. MATERIAL AND METHODS: This was a secondary analysis of a randomized, double-blind, placebo-controlled trial of twin pregnancies exposed to vaginal progesterone or placebo. Naturally conceived twin pregnancies with no prior history of preterm delivery, asymptomatic regarding preterm labor, who had undergone uterine contraction frequency monitoring from 24 to 34 weeks and 6 days were included in the study. Comparison of the mean frequency of uterine contractions between the treatment groups was performed. We also examined the influence of cervical length and chorionicity on the mean frequency of uterine contractions according to the group. RESULTS: The final analysis included 166 women in the progesterone and 170 in the placebo group. The baseline characteristics were similar in the two groups. Overall, no difference in the mean frequency of uterine contractions (p = 0.91) was observed between the progesterone (2.54 ± 3.19) and placebo (2.56 ± 3.59) groups. Also, no difference in the mean frequency of uterine contractions was observed between the groups in each week between 24 and 34 weeks and 6 days of gestation. Cervical length and chorionicity did not influence the frequency of contractions according to the progesterone or placebo treatment. CONCLUSIONS: Overall, progesterone does not influence the frequency of uterine contractions in twin pregnancies.
Asunto(s)
Embarazo Múltiple , Nacimiento Prematuro/prevención & control , Progesterona/administración & dosificación , Progestinas/administración & dosificación , Contracción Uterina/efectos de los fármacos , Administración Intravaginal , Adulto , Método Doble Ciego , Femenino , Humanos , Embarazo , Resultado del EmbarazoRESUMEN
PURPOSE OF REVIEW: This review summarizes the evidence of the effectiveness of progesterone on the rate of preterm birth and evaluates the most recent studies. RECENT FINDINGS: The incidence of preterm delivery is about 7-11% of all pregnant women and preterm birth is one of the most important causes of neonatal morbidity and mortality. Interventions to reduce such complications have been attempted for several years. Most efforts so far have been tertiary interventions, such as treatment with antenatal corticosteroids, tocolytic agents, and antibiotics. Some of these measures have reduced perinatal morbidity and mortality, but the incidence of preterm birth is increasing. Recently, researches have suggested prophylactic progesterone could reduce the preterm birth rate in a select group presenting previous preterm birth and a short cervical length by transvaginal scan at mid-trimester pregnancy. SUMMARY: This review intends to define the current indication for administration of progesterone for pregnant women. On the basis of current knowledge, progesterone should be offered to women with a documented history of a previous spontaneous birth at less than 37 weeks and for those found to have a short cervical length of 15 mm or less. Studies are needed to evaluate progesterone efficacy on other risk factors.
Asunto(s)
Trabajo de Parto Prematuro/prevención & control , Obstetricia/métodos , Nacimiento Prematuro/prevención & control , Progesterona/uso terapéutico , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Cuello del Útero/diagnóstico por imagen , Cuello del Útero/patología , Femenino , Humanos , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Tocolíticos/uso terapéutico , Ultrasonografía , Incompetencia del Cuello del Útero/diagnóstico por imagen , Incompetencia del Cuello del Útero/prevención & controlRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the effect of prophylactic vaginal progesterone in decreasing preterm birth rate in a high-risk population. STUDY DESIGN: A randomized, double-blind, placebo-controlled study included 142 high-risk singleton pregnancies. Progesterone (100 mg) or placebo was administered daily by vaginal suppository and all patients underwent uterine contraction monitoring with an external tocodynamometer once a week for 60 minutes, between 24 and 34 weeks of gestation. Progesterone (n = 72) and placebo (n = 70) groups were compared for epidemiologic characteristics, uterine contraction frequency, and incidence of preterm birth. Data were compared by chi(2) analysis and Fisher exact test. RESULTS: The preterm birth rate was 21.1% (30/142). Differences in uterine activity were found between the progesterone and placebo groups (23.6% vs 54.3%, respectively; P <.05) and in preterm birth between progesterone and placebo (13.8% vs 28.5%, respectively; P <.05). More women were delivered before 34 weeks in the placebo group (18.5%) than in the progesterone group (2.7%) (P <.05). CONCLUSION: Prophylactic vaginal progesterone reduced the frequency of uterine contractions and the rate of preterm delivery in women at high risk for prematurity.
Asunto(s)
Trabajo de Parto Prematuro/prevención & control , Progesterona/administración & dosificación , Adulto , Tasa de Natalidad , Método Doble Ciego , Femenino , Humanos , Placebos/uso terapéutico , Embarazo , Factores de Riesgo , Supositorios , Contracción Uterina/efectos de los fármacosRESUMEN
Objetivos: construir uma curva de altura uterina, em funçäo da idade gestacional, em populaçäo de gestantes normais. Analisar diferenças com as curvas existentes e avaliar a influência da cor, paridade e peso matemo na variaçäo da altura uterina. Métodos: entre julho de 1997 e julho de 1999, 100 gestantes sem intercorrências clínicas e/ou obstétricas foram submetidas a medidas de altura uterina, da 20ª à 42ª semana de gestaçäo. A idade gestacional foi confirmadda por ultra-sonografia em todos os casos. O mesmo observador realizou 726 medidas de altura uterina, com fita métrica, da borda superior da sínfise púbica ao fundo uterino. Resultados: foram obtidas curvas e tabelas de altura uterina em funçäo da idade gestacional. O crescimento da altura uterina foi, em média, 0,7 cm/semana...