AbstractWe represent the results of the combined method of treatment and prevention of miscarriage in women with a multiple pregnancy and a high risk of the threat of termination the pregnancy because of using the obstetric unloading pessaries, combined with micronized progesterone. The efficiency of this method of treatment is evidenced by the rapid elimination of clinical symptoms of threatened abortion, accelerating the regression of ultrasound markers, reducing the number of complications in of pregnant women and reducing the time of their stay in hospital.Goal: To evaluate the effectiveness of the handling the obstetric pessary in combination with micronized progesterone at women with multifetal pregnancy and a high risk of miscarriage.Materials and methods. We analyzed 120 cases of multifetal pregnancies with signs of miscarriage within the terms from 16 to 28 weeks. The first group of the examined women was: 40 pregnant women with twins and signs of miscarriage, who in the scheme of treatment and prophylactic measures were offered to use the unloading obstetric pessaries in combination with continuous therapy by natural micronized progesterone until 36 weeks of pregnancy. The second group included 40 pregnant women with twins, who were laid seam on the cervix because of istmicocervical insufficiency and were applied short-term courses of therapy by gestagens. The control group comprised 40 pregnant women with twins at the age of 16-28 weeks of pregnancy who were conducted the therapy about the threat of miscarriage according to the current clinical protocols (Order of the Ministry of Health of Ukraine No. 624). It was carried out the analysis of the course of pregnancy, childbirth, the postpartum period and the state of neonatal adaptation in the surveyed groups.Results of the research and their discussion. In the first group, urgent childbirth occurred in 34 (85%) cases, in group II in 29 (72.5%) cases, in control group – in 25 (62.5%) cases. Cesarean delivery was performed in 7 (17.5%) patients of group I pregnant women, in 9 (22.5%) of group II patients and in 11 (27.5%) in the pregnant group. When studying the state of neonatal adaptation of newborns in the examined groups, the following results were obtained. The average weight of the newborns in group I was 3245 ±280 g, in group II 2865 ±365 g, in the control group - 2975 ±325 g (p>0.05). The evaluation of the state of newborns on the Apgar scale, respectively at the 1st and 5th minutes, was respectively: in newborns of the I group, 7.5 ± 1.4 and 8.4 ± 1.3 points, in group II - 7.3 ± 1.6 and 8.2 ± 1.1 points, in the control group – 7.2 ± 1.6 and 8.6 ± 1.2 (р 1-р 2> 0.05).Conclusions. Comprehensive prophylaxis of non-pregnancy in multiple pregnancies, combining the use of a traumatic cardiac cervix with the help of unloading obstetric pussies with progesterone preparations, allows prolonging pregnancy, preventing the development of prematurity, contributes to the improvement of perinatal indicators.
Baranov YY, Tokova ZZ, Tadevosian AA. Perinatal outcomes in multiple births. Akusherstvo i hinekolohiya. 2012; 1: 98-102.
Vdovychenko YuP. Multiple pregnancy: A manual. Part II (for the enclave). Kyiv: 2011: 360.
Krasnopolskyi VY, Novykova SV, Kapustyna MV, Tytchenko LY, Aksenov AN, Zharova AA. Modern problems of multiple pregnancies. Rossiyskiy vestnik akushera-ginekologa. 2009; 2: 79-81.
Botting BJ, MacDonald-Davies I, MacFarland AJ. Recent trends in the incidence of multiple birth and associated mortality. Arch. Dis. Child. 2011; 62: 941-948. DOI: https://doi.org/10.1136/adc.62.9.941
Almonte L, Davis M, Ward C, Brown D, Craparo F. Spontaneous and non-spontaneous twins: a comparasion study of preterm labor, preterm premature rupture of membranes, gestational age at delivery, maternal age, and lenth of hospital stay. Twin Research and Human Genetics. 2012; 15: 2: 170.
Hassan SS, Romero R. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, doubleblind, placebocontrolled trial. Vidyadhari et al. Ultrasound in Obstetrics & Gynecology. 2011; 1: 18-31. DOI: https://doi.org/10.1002/uog.9017 [PMid:21472815 PMCid:PMC3482512]
Management of preterm labor. Practice Bulletin No. 127. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012; 119: 1308-13. DOI: https://doi.org/10.1097/AOG.0b013e31825af2f0 [PMid:22617615]
Romero R, Nicolaides K, Conde Agudelo A et al. Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data. Am. J. Obstet. Gynecol. 2012; 2 (124): 1-19. DOI: https://doi.org/10.1016/j.ajog.2011.12.003
Salazar EL, Calzada L The role of progesterone in endometrial estradiol and progesterone-receptor synthesis in women with menstrual disorders and habitual abortion. Gynecol. Endocrinol. 2007; 23 (4): 222-225. DOI: https://doi.org/10.1080/09513590701254030 [PMid:17505942]
Use of progesterone to reduce preterm birth/American College of Obstetricians and Gynecologists. Obstet Gynecol 2008; 112: 963-965. [PMid:18827143]
Lapach SN, Chubenko AV, Babych PN. Statistical methods in biomedical research using Exel. Kiyv: Moryon: 2000; 320.
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