Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.
Roziana Ramli MD, MMed(ObGyn)
Hospital Sultanah Nur Zahirah,K.Trg
IS MISCARRIAGE PREVENTABLE?
AND
THE USE OF PROGESTERONE ...
NO ONE TELLS A PREGNANT MUM…..
1. Yess!! Pregnant at last!
2. But, the good news
might not last all that
long…………………….
FACTS AND FIGURES
• Vaginal bleeding: most common cause of
consultation in early pregnancy
• Nearly 1/3rd. of women will e...
ANXIETY….
THE HOPEFUL - VIPS
Previous miscarriage
Recurrent miscarriages
Infertility
Mature mum
First time mum
Previous bad obstetri...
AND THE HISTORY GOES…
• Puan Rohana, 41 yo, married for 5 years
• Now, 2nd pregnancy with h/o of miscarriage @ 8/52
• At 6...
ULTRASOUND
• Diagnosis?
• Then what?
THEN WHAT?
• Questions:
1. To admit or not to admit?
2. What about bed rest?
3. How to address her fears?
4. Is miscarriag...
THEN WHAT?
• Questions:
1. To admit or not to admit?
2. How to address her fears?
3. Is miscarriage preventable?
4. What a...
TO ADMIT OR NOT ?
• 50 000 inpatient admissions in the UK annually (Dept
of Health statistics, 2005)
• Management of women...
TO ADMIT OR NOT?
• Patient’s profile
• Severity of vaginal bleeding
• Association with abdominal pain
• Physical examinati...
THEN WHAT?
• Questions:
1. To admit or not to admit?
2. What about bed rest?
3. How to address her fears?
4. Is there any ...
BED REST DURING PREGNANCY FOR
PREVENTING MISCARRIAGE
• Aleman A, Althabe F, Belizán JM, Bergel E. Bed rest during pregnanc...
Author Design N Sonography Intervention Intervention/no intervention
Cochrane 2 studies
Systematic Review 84 yes Bedrest R...
THEN WHAT?
• Questions:
1. To admit or not to admit?
2. What about bed rest?
3. How to address her fears?
4. Is miscarriag...
Vaginal bleeding in the first trimester of pregnancy
occurs in
about 25 % of pregnant women.
It is the commonest complicat...
Ectopic Pregnancy 1.5-2%
Miscarriage / non viable pregnancy 12-16%
Termination 16%
Ongoing Intra uterine Pregnancy 65-67%
...
Ectopic Pregnancy 1.5-2% 8-18%
Miscarriage / non viable pregnancy 12-16% 46%
Termination 16% NA
Ongoing Intra uterine Preg...
The short term consequences of early pregnancy bleeding
more than one half of those who bleed will loose their pregnancy
V...
50%
50%
The short term consequences of early pregnancy bleeding
more than one half of those who bleed will loose their pregnancy
T...
Predictive value of the presence of an embryonic
heartbeat for live birth: comparison of women with
and without recurrent ...
Favourable prognostic factors Adverse prognostic factors
History
Advancing gestational age Maternal age >34 years
Increasi...
THEN WHAT?
• Questions:
1. To admit or not to admit?
2. How to address her fears?
3. What about bed rest?
4. What about me...
VITAMIN SUPPLEMENTATION FOR
PREVENTING MISCARRIAGE
• Rumbold A, Middleton P, Pan N, Crowther CA. Vitamin supplementation f...
UTERINE MUSCLE RELAXANT DRUGS FOR
THREATENED MISCARRIAGE
• Lede R, Duley L
• Obstetrics and Gynecology, University of Buen...
HCG?
HUMAN CHORIONIC GONADOTROPHIN
FOR THREATENED MISCARRIAGE
• Devaseelan P, Fogarty PP, Regan L. Human chorionic
gonadotrophi...
CAUSES OF MISCARRIAGE
• Chromosomal abnormalities (60%)
• Infections and diseases (CMV, Chlamydia, Mycoplasma, DM)
• Autoi...
CAUSES OF MISCARRIAGE
• Chromosomal abnormalities (60%)
• Infections and diseases (CMV, Chlamydia, Mycoplasma, DM)
• Autoi...
CAUSES OF MISCARRIAGE
• Chromosomal abnormalities (60%)
• Infections and diseases (CMV, Chlamydia, Mycoplasma, DM)
• Autoi...
THE MANAGEMENT OF THREATENED
ABORTION
PAUL BOULLE, M.B., CH.B., M.R.C.A.G., F.C.A.G. CS.A.), GYNAECOLOGIST AND
OBSTELRICIA...
INDIRECT EVIDENCE OF PROGESTERONE
EFFICACY
• Removal of the corpus luteum during
pregnancy  Abortion
• Luteal phase insuf...
GESTATIONAL AGE
• Peak in bleeding coincides with
the development of a
hormonally functional placenta
• The shift from lut...
100.0
50.0
10.0
5.0
1.0
0.5
0.1
0.05
4 8 12 14 16 20 24 28 32 36 40
Progesterone (ng/mL)
Weeks of Pregnancy
Plasma levels ...
• First-trimester P values
>25 ng/mL suggest a normal
IUP 98% of the time, while
pregnancies with P values
<5 ng/mL are no...
Serum
progesterone (ng/ml)
Spontaneous
miscarriage
Intrauterine
pregnancy
0 - 4.9
5.0 - 9.9
10.0 - 14.9
15.0 - 19.9
20.0 -...
PROGESTERONE
• A meta-analysis of 26 studies showed that progesterone
values did well at discriminating between pregnancy
...
DOES THIS APPROACH WORK?
• ?
Omar et al . Dydrogesterone in threatened abortion: pregnancy outcome.
J Steroid Biochem Mol Biol 2005; 97: 421-425
Mild t...
CH3
COCH3
CH3
O
H
Duphaston®
(dydrogesterone)
CH3
COCH3
CH3
O
H
progesterone
Duphaston : more studies – basic and clinical
154 Women included:
– 74 received dydrogesterone
– 80 in the control group
DYDROGESTERONE IN THREATENED MISCARRIAGE
Omar e...
Pandian Ramachandhiran et al. Dydrogesterone in threatened miscarriage:
a Malaysian experience. Maturitas 2009; 65 Suppl 1...
PROGESTOGEN FOR TREATING
THREATENED MISCARRIAGE (REVIEW)
• Wahabi HA, Fayed AA, Esmaeil SA, Al Zeidan RA. Progestogen for ...
Wahabi HA et al. Cochrane Collaboration.
Progestogen for treating threatened miscarriage 2007
PROGESTOGEN FOR PREVENTING
MISCARRIAGE (REVIEW)
• Haas DM, Ramsey PS. Progestogen for preventing miscarriage. Cochrane
Dat...
IS MISCARRIAGE PREVENTABLE?
YESNO
Is miscarriage preventable? gynae symposium
Is miscarriage preventable? gynae symposium
Is miscarriage preventable? gynae symposium
Is miscarriage preventable? gynae symposium
Is miscarriage preventable? gynae symposium
Is miscarriage preventable? gynae symposium
Is miscarriage preventable? gynae symposium
Prochain SlideShare
Chargement dans…5
×

Is miscarriage preventable? gynae symposium

2 960 vues

Publié le

Publié dans : Formation, Santé & Médecine
  • Discover How to Cure uterine fibroids and PCOS At Any Age, Even If You’ve Tried Everything And Nothing Has Ever Worked For You Before ♥♥♥ http://t.cn/Aig7bySW
       Répondre 
    Voulez-vous vraiment ?  Oui  Non
    Votre message apparaîtra ici
  • Who Else Wants To Cure Their uterine fibroids, Regain Their Natural Inner Balance and Achieve LASTING Freedom From PCOS Related Symptoms? ♥♥♥ https://tinyurl.com/rbqozdv
       Répondre 
    Voulez-vous vraiment ?  Oui  Non
    Votre message apparaîtra ici
  • Discover A Simple Holistic System For Curing uterine fibroids and PCOS Once And For All using 100% Guaranteed All-Natural Method. ▲▲▲ http://t.cn/Aig7c6mX
       Répondre 
    Voulez-vous vraiment ?  Oui  Non
    Votre message apparaîtra ici
  • Don't even THINK about buying any uterine fibroids product, drugs or going on a gimmick fibroids program until you read my revealing, no-holds barred holistic uterine fibroids cure book. ■■■ http://t.cn/Aig7c6mX
       Répondre 
    Voulez-vous vraiment ?  Oui  Non
    Votre message apparaîtra ici
  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m77EgH } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m77EgH } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m77EgH } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Répondre 
    Voulez-vous vraiment ?  Oui  Non
    Votre message apparaîtra ici

Is miscarriage preventable? gynae symposium

  1. 1. Roziana Ramli MD, MMed(ObGyn) Hospital Sultanah Nur Zahirah,K.Trg IS MISCARRIAGE PREVENTABLE? AND THE USE OF PROGESTERONE IN EARLY PREGNANCY
  2. 2. NO ONE TELLS A PREGNANT MUM….. 1. Yess!! Pregnant at last! 2. But, the good news might not last all that long…………………….
  3. 3. FACTS AND FIGURES • Vaginal bleeding: most common cause of consultation in early pregnancy • Nearly 1/3rd. of women will experience bleeding in their first trimester • ? First sign of a possible miscarriage (10-20% of all recognised pregnancies)
  4. 4. ANXIETY….
  5. 5. THE HOPEFUL - VIPS Previous miscarriage Recurrent miscarriages Infertility Mature mum First time mum Previous bad obstetric history e.g IUD
  6. 6. AND THE HISTORY GOES… • Puan Rohana, 41 yo, married for 5 years • Now, 2nd pregnancy with h/o of miscarriage @ 8/52 • At 6/52 pregnancy, had PV spotting • Examination unremarkable, vaginal exam: closed cervix • Ultrasound:
  7. 7. ULTRASOUND • Diagnosis? • Then what?
  8. 8. THEN WHAT? • Questions: 1. To admit or not to admit? 2. What about bed rest? 3. How to address her fears? 4. Is miscarriage preventable? 5. What about medicine? • Look at the evidence ladies & gentlemen,
  9. 9. THEN WHAT? • Questions: 1. To admit or not to admit? 2. How to address her fears? 3. Is miscarriage preventable? 4. What about bed rest? 5. What about medicine?
  10. 10. TO ADMIT OR NOT ? • 50 000 inpatient admissions in the UK annually (Dept of Health statistics, 2005) • Management of women referred to early pregnancy assessment unit (EPAU): care and cost effectiveness. Bigrigg MA, Read MD, BMJ 1991;302:577–9 • An effective unit should be in a dedicated area: • good quality ultrasound, • easy access to lab (for rh grouping, sensitive UPT and -hCG assay) • gynaecological procedures.
  11. 11. TO ADMIT OR NOT? • Patient’s profile • Severity of vaginal bleeding • Association with abdominal pain • Physical examination findings • Ultrasound findings
  12. 12. THEN WHAT? • Questions: 1. To admit or not to admit? 2. What about bed rest? 3. How to address her fears? 4. Is there any medicine to give? • Look at the facts ladies & gentlemen,
  13. 13. BED REST DURING PREGNANCY FOR PREVENTING MISCARRIAGE • Aleman A, Althabe F, Belizán JM, Bergel E. Bed rest during pregnancy for preventing miscarriage. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD003576. DOI: 10.1002/14651858.CD003576.pub2 • No statistically significant difference in the risk of miscarriage in the bed rest group versus the no bed rest group (placebo or other treatment) (risk ratio (RR) 1.54, 95% confidence interval (CI) 0.92 to 2.58). • Neither bed rest in hospital nor bed rest at home showed a significant difference in the prevention of miscarriage. • Authors' conclusions: • There is insufficient evidence of high quality that supports a policy of bed rest in order to prevent miscarriage in women with confirmed fetal viability and vaginal bleeding in first half of pregnancy.
  14. 14. Author Design N Sonography Intervention Intervention/no intervention Cochrane 2 studies Systematic Review 84 yes Bedrest RR 1.54 ; 0.92-2.58 Pregnancy outcome in studies with various therapeutic regimens Aleman A et al. Bed rest during pregnancy for preventing miscarriage. The Cochrane Database of Systematic Reviews 2005 • Little evidence of its value. • Physical activity: rarely a/w increased risk of miscarriage • Lack of activity: thromboembolic events, back pain, muscle atrophy and bone loss. • Bed rest: emotional, familial and economic stress as well as self- blame if fail to comply and subsequently suffer a miscarriage.
  15. 15. THEN WHAT? • Questions: 1. To admit or not to admit? 2. What about bed rest? 3. How to address her fears? 4. Is miscarriage preventable? 5. What about medicine? • Look at the facts ladies & gentlemen,
  16. 16. Vaginal bleeding in the first trimester of pregnancy occurs in about 25 % of pregnant women. It is the commonest complication in early pregnancy Hasan R et al. Association between first trimester vaginal bleeding and miscarriage. Obstet Gynecol 2009;114: 860-7 FACTS:
  17. 17. Ectopic Pregnancy 1.5-2% Miscarriage / non viable pregnancy 12-16% Termination 16% Ongoing Intra uterine Pregnancy 65-67% Outcome of first trimester pregnancy Herbert D; Lucke J; Dobson A . Pregnancy losses in young Australian women: findings from the Australian Longitudinal Study on Women's Health. J. Womens Health Issues; 2009 ; 19: 21-9. Blohm F, Friden B, Milsom I. Prospective longitudinal population based study of clinical miscarriage in an urban swedisch population. BJOG 2008; 115: 176-8.
  18. 18. Ectopic Pregnancy 1.5-2% 8-18% Miscarriage / non viable pregnancy 12-16% 46% Termination 16% NA Ongoing Intra uterine Pregnancy 65-67% 38-46% Outcome of first trimester pregnancy Herbert D; Lucke J; Dobson A . Pregnancy losses in young Australian women: findings from the Australian Longitudinal Study on Women's Health. J. Womens Health Issues; 2009 ; 19: 21-9. Blohm F, Friden B, Milsom I. Prospective longitudinal population based study of clinical miscarriage in an urban swedisch population. BJOG 2008; 115: 176-8. Bleeding/Pain
  19. 19. The short term consequences of early pregnancy bleeding more than one half of those who bleed will loose their pregnancy Van Oppenraay RHF et al. Predicting adverse obstetric outcome after early pregnancy events and complications: .a review Human Reproduction Update 2009;15:409-421
  20. 20. 50% 50%
  21. 21. The short term consequences of early pregnancy bleeding more than one half of those who bleed will loose their pregnancy The long-term consequences of early pregnancy bleeding In ongoing pregnancies, adverse outcomes are reported for - very preterm delivery (< 34 weeks) OR 1.9 (1.6-2.2) - low birth weight (<2500 g) OR 2.3 (1.9-2.7) - ante partum haemorrhage OR 1.8 (1.7-2.0) Van Oppenraay RHF et al. Predicting adverse obstetric outcome after early pregnancy events and complications: .a review Human Reproduction Update 2009;15:409-421
  22. 22. Predictive value of the presence of an embryonic heartbeat for live birth: comparison of women with and without recurrent pregnancy loss. Hyer JS, Fong S, Kutteh WH., Fertil Steril 2004 Nov;82(5):1369-73. If heartbeat is visible, the probability of a continued pregnancy is better than 95%.
  23. 23. Favourable prognostic factors Adverse prognostic factors History Advancing gestational age Maternal age >34 years Increasing number of previous miscarriages Sonography Fetal heart activity at presentation Fetal bradycardia Discrepancy between GA and CRL Empty GS >15-17 mm Maternal serum biochemistry Normal levels of these markers Low β hCG values Free β hCG value of 20 ng/ml β hCG increase <66% in 48 hrs Bioactive/immunoreactive ratio hCG <0.5 Progesterone <45 nmol/l in 1st trimester Inhibin A <0.553 MOM CA125 level ≥43.1 U/mL in 1st trimester
  24. 24. THEN WHAT? • Questions: 1. To admit or not to admit? 2. How to address her fears? 3. What about bed rest? 4. What about medicine? • Look at the facts ladies & gentlemen,
  25. 25. VITAMIN SUPPLEMENTATION FOR PREVENTING MISCARRIAGE • Rumbold A, Middleton P, Pan N, Crowther CA. Vitamin supplementation for preventing miscarriage. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD004073. DOI: 10.1002/14651858.CD004073.pub3 January 19, 2011 • 28 trials involving 96,674 women and 98,267 pregnancies • No significant differences were seen between women taking any vitamins compared with controls for total fetal loss (relative risk (RR) 1.04, 95% confidence interval (CI) 0.95 to 1.14), early or late miscarriage (RR 1.09, 95% CI 0.95 to 1.25) or stillbirth (RR 0.86, 95% CI 0.65 to 1.13) • Compared with controls, women given any type of vitamin(s) pre or peri-conception were more likely to have a multiple pregnancy (RR 1.38, 95% CI 1.12 to 1.70, three trials, 20,986 women).
  26. 26. UTERINE MUSCLE RELAXANT DRUGS FOR THREATENED MISCARRIAGE • Lede R, Duley L • Obstetrics and Gynecology, University of Buenos Aires, Argentinian Institute for Evidence Based Medicine, Av. Roque Saenz Peña 825, Buenos Aires, Argentina, 1035. CONCLUSION: • There is insufficient evidence to support the use of uterine muscle relaxant drugs for women with threatened miscarriage. • PMID: 16034877 [PubMed - indexed for MEDLINE]
  27. 27. HCG?
  28. 28. HUMAN CHORIONIC GONADOTROPHIN FOR THREATENED MISCARRIAGE • Devaseelan P, Fogarty PP, Regan L. Human chorionic gonadotrophin for threatened miscarriage. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD007422. DOI: 10.1002/14651858.CD007422.pub2 • hCG is secreted by the syncytiotrophoblast to promote corpus luteum to secrete progesterone and helps in maintaining the pregnancy. • No statistically significant difference in the incidence of miscarriage between hCG and 'no hCG' (placebo or no treatment) groups (Risk ratio (RR) 0.66; 95% confidence interval (CI) 0.42 to 1.05).
  29. 29. CAUSES OF MISCARRIAGE • Chromosomal abnormalities (60%) • Infections and diseases (CMV, Chlamydia, Mycoplasma, DM) • Autoimmune diseases • Low progesterone levels • Other possible causes (radiation, chemo, drugs, smoking)
  30. 30. CAUSES OF MISCARRIAGE • Chromosomal abnormalities (60%) • Infections and diseases (CMV, Chlamydia, Mycoplasma, DM) • Autoimmune diseases • Low progesterone levels • Other possible causes (radiation, chemo, drugs, smoking)
  31. 31. CAUSES OF MISCARRIAGE • Chromosomal abnormalities (60%) • Infections and diseases (CMV, Chlamydia, Mycoplasma, DM) • Autoimmune diseases • Low progesterone levels • Other possible causes (radiation, chemo, drugs, smoking) • Evidences?
  32. 32. THE MANAGEMENT OF THREATENED ABORTION PAUL BOULLE, M.B., CH.B., M.R.C.A.G., F.C.A.G. CS.A.), GYNAECOLOGIST AND OBSTELRICIAN, DURBAN S.A. MEDICAL JOURNAL 1966 • 1I. Psychology • 2. Bed Rest • 3. Sedation • 4. Antispasmodics • 5. Surgery • 6. Hormones
  33. 33. INDIRECT EVIDENCE OF PROGESTERONE EFFICACY • Removal of the corpus luteum during pregnancy  Abortion • Luteal phase insufficiency • Assisted reproductive technologies’ experience with progesterone • RU 486 or Mifepristone (anti-progesterone) for pregnancy termination
  34. 34. GESTATIONAL AGE • Peak in bleeding coincides with the development of a hormonally functional placenta • The shift from luteal to placental production of progesterone: 7 weeks of pregnancy Patterns and predictors of vaginal bleeding in the first trimester of pregnancy; Reem Hassan et.al Ann Epidemiol. 2010July; 20(7): 524-531 • The risk of threatened miscarriage to proceed to full miscarriage depends on GA (Weiss et al., 2004; Schauberger et al.) weeks pregnancy %
  35. 35. 100.0 50.0 10.0 5.0 1.0 0.5 0.1 0.05 4 8 12 14 16 20 24 28 32 36 40 Progesterone (ng/mL) Weeks of Pregnancy Plasma levels during pregnancy reach 125-200 ng/ml (vs 11ng/mL during luteal phase)
  36. 36. • First-trimester P values >25 ng/mL suggest a normal IUP 98% of the time, while pregnancies with P values <5 ng/mL are non-viable. 100 200 300 400 500 4 8 12 20 Weeks of Pregnancy ProgesteroneConcentration nmol/l Serum progesterone levels during pregnancy First trimester Second trimester Third trimester 47 – 1159 nmol/l 50-310 nmol/l 2540- 636 nmol/l
  37. 37. Serum progesterone (ng/ml) Spontaneous miscarriage Intrauterine pregnancy 0 - 4.9 5.0 - 9.9 10.0 - 14.9 15.0 - 19.9 20.0 - 24.9 1093 (85.5%) 46 (65.8%) 181 (31.3%) 59 (9.8%) 39 (7.7%) 2 (0.2%) 126 (17.8%) 338 (58.4%) 509 (84.4%) 451 (88.8%)
  38. 38. PROGESTERONE • A meta-analysis of 26 studies showed that progesterone values did well at discriminating between pregnancy failure and viable intrauterine pregnancy. • The most logical approach to manage threatened miscarriage caused by low endogenous progesterone therefore is by administering exogenous progesterone
  39. 39. DOES THIS APPROACH WORK? • ?
  40. 40. Omar et al . Dydrogesterone in threatened abortion: pregnancy outcome. J Steroid Biochem Mol Biol 2005; 97: 421-425 Mild to moderate vaginal bleeding Gestational age < 13 weeks No history of recurrent miscarriage No loss of conception materials Absence of systemic illness or fever Absence of an empty sac of > 26 mm Presence of gestational sac at 5 weeks Presence of yolk sac at 5 – 6 weeks Presence of cardiac activity at 7 weeks Inclusion Intervention Treatment group: dydrogesterone 40 mg at presentation plus 10 mg b.i.d. until bleeding stopped. bed rest and folic acid. Control group: bed rest and folic acid only. Women were followed up until 20 weeks gestation DYDROGESTERONE IN THREATENED MISCARRIAGE
  41. 41. CH3 COCH3 CH3 O H Duphaston® (dydrogesterone) CH3 COCH3 CH3 O H progesterone Duphaston : more studies – basic and clinical
  42. 42. 154 Women included: – 74 received dydrogesterone – 80 in the control group DYDROGESTERONE IN THREATENED MISCARRIAGE Omar et al . Dydrogesterone in threatened abortion: pregnancy outcome. J Steroid Biochem Mol Biol 2005; 97: 421-425
  43. 43. Pandian Ramachandhiran et al. Dydrogesterone in threatened miscarriage: a Malaysian experience. Maturitas 2009; 65 Suppl 1:S47-50. N= 191 p<0.05 OR: 0.36 95% CI 0.17 - 0.75). DYDROGESTERONE IN THREATENED MISCARRIAGE
  44. 44. PROGESTOGEN FOR TREATING THREATENED MISCARRIAGE (REVIEW) • Wahabi HA, Fayed AA, Esmaeil SA, Al Zeidan RA. Progestogen for treating threatened miscarriage. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD005943. DOI: 10.1002/14651858.CD005943.pub4 • Meta analysis of four studies (421 participants) • There was evidence of a reduction in the rate of spontaneous miscarriage with the use of progestogens compared to placebo or no treatment (risk ratio (RR) 0.53; 95% (CI) 0.35 to 0.79).
  45. 45. Wahabi HA et al. Cochrane Collaboration. Progestogen for treating threatened miscarriage 2007
  46. 46. PROGESTOGEN FOR PREVENTING MISCARRIAGE (REVIEW) • Haas DM, Ramsey PS. Progestogen for preventing miscarriage. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD003511. DOI: 10.1002/14651858.CD003511.pub2 • Meta analysis of fifteen trials (2118 women) are included • No statistically significant difference in the risk of miscarriage between progestogen and placebo or no treatment group(Peto OR) 0.98; 95% (CI) 0.78 to 1.24) • Statistically significant decrease in miscarriage rate compared to placebo or no treatment (Peto OR 0.38; 95% CI 0.20 to 0.70) in subgroup patients with recurrent miscarriages.
  47. 47. IS MISCARRIAGE PREVENTABLE? YESNO

×