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Peng Y, Zhang J, Lan T, Liu S, Ye T, Wang Y. Meta analysis of the effect of phloroglucinol combined with progesterone in the treatment of threatened miscarriage before 20 weeks of gestation: A protocol for a systematic review. Medicine (Baltimore) 2022; 101:e31885. [PMID: 36451473 PMCID: PMC9704879 DOI: 10.1097/md.0000000000031885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Threatened miscarriage (TM) is an important factor endangering the health of pregnant women. It not only affects women's physical and mental health, but also destroys family happiness. To treat this disease, it is necessary to find a treatment with better clinical efficacy and fewer side effects. The purpose of this systematic study was to evaluate the efficacy and safety of phloroglucinol (PHL) combined with progesterone in the treatment of TM before 20 weeks of pregnancy. METHODS Electronic databases (EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Elsevier, China National Knowledge Infrastructure, Chongqing VIP, and WanFang Data) were searched from inception until September. 2022. Randomized controlled trials of PHL combined with progesterone in the treatment of TM before 20 weeks of gestation will be included, and all articles will be independently screened and collected by 2 reviewers. Revman 5.3.5 software will be used for meta-analysis. The specific process is described in the Cochrane Handbook for Systematic Reviews. RESULTS The efficacy and safety of PHL combined with progesterone for the treatment of threatened abortion were comprehensively evaluated in terms of efficacy, efficiency, time of symptom relief, length of hospital stay, and incidence of adverse events. CONCLUSION This study provides reliable evidence for the clinical application of PHL combined with progesterone for the treatment of TM.
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Affiliation(s)
- Yao Peng
- The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | | | - Tian Lan
- The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | - Shengyue Liu
- The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | - Tao Ye
- The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | - Yongzhou Wang
- The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
- * Correspondence: Yongzhou Wang, Department of Gynecology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou 646000, China (e-mail: )
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Abstract
Dydrogesterone is an orally active synthetic progestogen, with a molecular structure similar to that of natural progesterone. As dydrogesterone does not inhibit ovulation at standard doses, is devoid of estrogenic or androgenic properties, and does not induce metabolic side effects, it is suitable for use throughout a woman's lifetime, from adolescence to older age, for conditions associated with altered levels of endogenous progesterone. Aside from its well established role as a component of menopausal hormone therapy, dydrogesterone is indicated in younger women for treatment of dysmenorrhea, irregular menstrual cycles, premenstrual syndrome, and threatened or recurrent miscarriage; and is effective as luteal phase support during assisted reproduction techniques. In this narrative review, evidence is examined for use of dydrogesterone across a range of disorders affecting menses and pregnancy. A case study woven into the review illustrates the clinical uses of dydrogesterone during a young woman's journey to become a mother.
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Affiliation(s)
- Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Bern, Bern, Switzerland
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Parveen R, Khakwani M, Tabassum S, Masood S. Oral versus Vaginal Micronized Progesterone for the Treatment of Threatened Miscarriage. Pak J Med Sci 2021; 37:628-632. [PMID: 34104138 PMCID: PMC8155417 DOI: 10.12669/pjms.37.3.3700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: This study was planned with an aim to find out the effectiveness of oral versus vaginal micronized progesterone for the treatment of threatened miscarriage. Methods: This randomized controlled trial was conducted at The Department of Obstetrics and Gynaecology, Nishtar Hospital Multan, from August 2019 to January 2020. A total of 136 pregnant women, aged 18 to 45 years having vaginal bleeding were included and divided into two groups (68 women in each group). Participants in the Group-A were given oral micronized progesterone as 200mg twice a day while Group-B participants were given vaginal progesterone suppository 400mg once a day. All women were followed up until 20th week of their pregnancy. Outcome was labeled as prevention of miscarriage if woman had no bleeding per vagina and pregnancy went beyond 20th weeks of gestation. Results: In a total of 136 women enrolled, mean age was noted to be 30.85+3.34 years. Overall, mean gestational age was noted to be 9.3+2.7 weeks. A total of 98 women (49 in each group) completed the follow up and were included in the final analysis regarding outcome. Among Groups-A, 45 (91.8) had prevention of miscarriage while 4 (9.2%) had miscarriage in comparison to 36 (73.5%) in Group-B had prevention of miscarriage whereas 13 (26.5%) had miscarriage and this difference was statistically significant in between the both study groups as women in Group-A had significantly better outcome in terms of prevention of miscarriage. (P value = 0.0164). Conclusion: The use of oral micronized progesterone was found to be significantly more effective than vaginal progesterone in women with threatened miscarriage.
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Affiliation(s)
- Rashida Parveen
- Rashida Parveen, FCPS (OBG). Department of Obstetrics and Gyne, Unit-II, Nishtar Medical University Hospital, Multan, Pakistan
| | - Mehnaz Khakwani
- Mehnaz Khakwani, FCPS (OBG). Department of Obstetrics and Gyne, Unit-II, Nishtar Medical University Hospital, Multan, Pakistan
| | - Sobia Tabassum
- Sobia Tabassum, FCPS (OBG). Department of Obstetrics and Gyne, Civil Hospital, Bahawalpur, Pakistan
| | - Sajjad Masood
- Sajjad Masood, FCPS (OBG). Department of Obstetrics and Gyne, Unit-II, Nishtar Medical University Hospital, Multan, Pakistan
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Zeng P, Zhou H, Guo P, Xia W, Huang J, Zeng Q. Efficacy and safety of traditional Chinese herbal medicine in the treatment of threatened abortion: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23288. [PMID: 33592821 PMCID: PMC7870177 DOI: 10.1097/md.0000000000023288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Threatened abortion (TA) is the commonest complication that occurs in early pregnancy, especially in 8-12 gestational weeks when the secretion of estrogen and progesterone shifts from corpus luteum to placental. Conventional therapies are little evidence of their value. In China, traditional Chinese herbal medicine has been widely used for the treatment of TA for a long time. The lack of strong scientific evidences make this a priority area for research. We aim to evaluate the efficacy and safety of traditional Chinese herbal medicine in the treatment of TA, provide medical staffs with more useful information, and provide patients with better advises. METHODS We will search 8 databases and additional sources, including the Web of Science, PubMed, Cochrane Library, Embase, CBM, Wanfang, VIP, CNKI, and WHO ICTRP, ChiCTR, Clinical Trials, Grey Literature Database, for potentially eligible studies. Literature search, screening and retrieval are performed independently by two researchers. In the event of a dispute, a third party will be consulted to support the judgment. We will use RevmanV.5.3 to perform a fixed-effect meta-analysis for clinical homogeneity study data, and the level of evidence will be assessed using the GRADE method. RESULTS This systematic review and meta-analysis will put a high-quality synthesis of the efficacy and safety of traditional Chinese herbal medicine in the treatment of TA. CONCLUSION The conclusion of this systematic review will provide evidence to assess traditional Chinese herbal medicine therapy whether is an efficacy and safe intervention to treat TA. ETHICS AND DISSEMINATION Since this article does not contain patient personal information, ethical approval is not required. The contract is distributed by a peer-reviewed journal or conference report. REGISTRATION NUMBER 10.17605/OSF.IO/DG3T8.
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Affiliation(s)
- Pengfei Zeng
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine
| | - Hang Zhou
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine
| | - Pei Guo
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine
| | - Wanting Xia
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine
| | - Jinzhu Huang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Qian Zeng
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine
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5
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Li L, Chen Y, Yang Y, Yang Y, Yang L, Wang Z. Rapid and sensitive analysis of progesterone by solid-phase extraction with amino-functionalized metal-organic frameworks coupled to direct analysis in real-time mass spectrometry. Anal Bioanal Chem 2020; 412:2939-2947. [DOI: 10.1007/s00216-020-02535-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 01/20/2023]
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Dissanayake MV, Darney BG, Caughey AB, Horner-Johnson W. Miscarriage Occurrence and Prevention Efforts by Disability Status and Type in the United States. J Womens Health (Larchmt) 2019; 29:345-352. [PMID: 31750752 DOI: 10.1089/jwh.2019.7880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Very little is known about early pregnancy loss in women with disabilities. To address this gap, we analyzed nationally representative data on miscarriage and receipt of care focused on miscarriage prevention among women with and without disabilities. Materials and Methods: We used 2011-2015 National Survey of Family Growth data on women with at least one completed pregnancy within the past 5 years. Bivariate and multivariate analyses assessed the association of six disability categories (any, hearing, vision, cognitive, physical, independent living) with miscarriage occurrence and receipt of services intended to prevent miscarriage. Results: Our analytic sample included 3,843 women with 5,776 completed pregnancies within the past 5 years. Overall, 31.63% of women with disabilities and 21.83% of women without disabilities had had a miscarriage within the past 5 years. Compared to women without disabilities, women with any, cognitive, physical, and independent living disability had higher adjusted odds of experiencing miscarriage (any disability aOR = 1.65 [95% CI: 1.21-2.25]). These women also had higher odds of receiving services to prevent miscarriage compared with women without disabilities (any disability aOR = 1.71 [95% CI: 1.20-2.45]). Among women who received services, higher proportions of women with any, vision, physical, or independent living disability received recommendations for bed rest (e.g., 65.007% of women with independent living disability vs. 33.98% of women without disability, p = 0.018). Conclusions: In a representative sample of U.S. women, we found significant differences in the odds of miscarriage and in receipt of care to prevent miscarriage between women with and without disabilities. Further research is needed to understand why women with disabilities are more likely to experience a miscarriage. Such research is important for informing care recommendations.
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Affiliation(s)
- Mekhala V Dissanayake
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Blair G Darney
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon.,School of Public Health, Oregon Health & Science University/Portland State University, Portland, Oregon.,National Institute of Public Health (INSP), Center for Population Health Research (CISP), Cuernavaca, Mexico
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Willi Horner-Johnson
- School of Public Health, Oregon Health & Science University/Portland State University, Portland, Oregon.,Institute on Development and Disability, Oregon Health & Health University, Portland, Oregon
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Yuan S, Gao F, Xin Z, Guo H, Shi S, Shi L, Yang X, Guan J. Comparison of the efficacy and safety of phloroglucinol and magnesium sulfate in the treatment of threatened abortion: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e16026. [PMID: 31192955 PMCID: PMC6587576 DOI: 10.1097/md.0000000000016026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To compare the clinical efficacy and safety of phloroglucinol (PHL) and magnesium sulfate (MS) in the treatment of threatened abortion through systematic review. METHODS Foreign databases, such as the Cochrane Library, PubMed and EMBASE, and Chinese databases, including the China Biology Medicine disc (SinoMed), China National Knowledge Infrastructure (CNKI), Chongqing VIP (VIP) and WanFang Data, were searched. Published randomized controlled trials (RCTs) documents obtained from these databases were included if they were associated with the research objective. The search timeframe was from the beginning of the establishment of each database to May 2018. Document selection, data abstraction and document quality evaluation were independently performed by 2 investigators. A combined analysis of the data was performed for those documents that fulfilled the study requirements; Rev Man 5.3 and Stata 12.0 software were used to compare and analyze the 2 drugs in terms of the total effective rate (TER), rate of adverse events, time required to relieve uterine contractions, onset time, time of complete relief of uterine contraction symptoms, medication duration and length of hospital stay. RESULTS A total of 21 RCT trials were included in the present research, according to the inclusion criteria. However, the quality of the included studies was low. The meta-analysis suggested that the TER and drug onset time of PHL were higher than those for MS, while the rate of adverse events, the time required to relieve uterine contractions, time to complete relief of uterine contraction symptoms, drug continuous treatment time and length of hospital stay were shorter than those for MS. CONCLUSION The clinical efficacy of PHL is better than that of MS, and PHL obviously results in fewer adverse reactions than MS. However, due to poor quality of evidence, high quality, multi-center RCTs with large samples are required for further verification.
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Affiliation(s)
- Shaofei Yuan
- Department of Pharmacy, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Fengli Gao
- Department of Pharmacy, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Zhong Xin
- Department of Pharmacy, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Haijun Guo
- Department of Pharmacy, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Suqin Shi
- Department of Pharmacy, The Second Affiliated Hospital of Baotou Medical College, Baotou
| | - Lei Shi
- Department of Pharmacy, Huhhot First Hospital, Yuquan District, Huhhot, Inner Mongolia
| | - Xia Yang
- Department of Pharmacy, Baogang Hospital (The Third Affiliated Hospital of Inner Mongolia Medical University), Kundulun District, Baotou, Inner Mongolia Autonomous Region
| | - Jingzhi Guan
- Department of Pharmacy, Inner Mongolia International Mongolian Hospital, Hohhot, Inner Mongolia, China
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Lee HJ, Norwitz E, Lee B. Relationship between threatened miscarriage and gestational diabetes mellitus. BMC Pregnancy Childbirth 2018; 18:318. [PMID: 30081861 PMCID: PMC6080503 DOI: 10.1186/s12884-018-1955-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/27/2018] [Indexed: 12/16/2022] Open
Abstract
Background Both threatened miscarriage and gestational diabetes mellitus (GDM) are common complications of pregnancy. However, only one pilot study has reported that these complications are not related. We aimed to investigate whether threatened miscarriage is one of the risk factors of GDM. Methods An unmatched case-control study of 1567 pregnant Korean women who underwent a two-step approach to diagnose GDM was retrospectively conducted. The eligible women were classified into normal (n = 840), borderline GDM (n = 480), and GDM (n = 247) groups. We analyzed the associations with threatened miscarriage in all groups with adjustment for confounding factors. Results The proportion of women who experienced threatened miscarriage was significantly lower in the GDM group than in the normal group (adjusted odds ratio (OR), 0.38; 95% confidence interval (CI), 0.18–0.78). It was significantly lower in the maternal hyperglycemia group (borderline GDM and GDM groups) than in the normal group (adjusted OR, 0.66; 95% CI, 0.47–0.91). The proportion of women who experienced threatened miscarriage was also significantly lower in the GDM group than in the normal (adjusted OR, 0.35; 95% CI, 0.17–0.70) and borderline GDM groups (adjusted OR, 0.46; 95% CI, 0.22–0.94). Moreover, the proportion of women who experienced threatened miscarriage significantly decreased according to the severity of glucose intolerance (adjusted OR, 0.94; 95% CI, 0.76–1.16). Conclusion This study demonstrates that threatened miscarriage is associated with decreased risk of GDM and the severity of glucose intolerance in Korean women. Additional studies are warranted to understand the pathophysiologic mechanisms that might exist between these frequent complications of pregnancy.
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Affiliation(s)
- Hee Joong Lee
- Department of Obstetrics & Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Errol Norwitz
- Department of Obstetrics & Gynecology, Tufts University School of Medicine, Boston, MA, USA
| | - Banghyun Lee
- Department of Obstetrics and Gynecology, Hallym University Kangdong Sacred Heart Hospital, 150, Seongan-ro, Gangdong-gu, Seoul, Republic of Korea.
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Monastra G, De Grazia S, Cilaker Micili S, Goker A, Unfer V. Immunomodulatory activities of alpha lipoic acid with a special focus on its efficacy in preventing miscarriage. Expert Opin Drug Deliv 2016; 13:1695-1708. [DOI: 10.1080/17425247.2016.1200556] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Giovanni Monastra
- Department of Experimental Medicine, University la Sapienza, Rome, Italy
| | - Sara De Grazia
- Department of Research and Development, LO.LI. Pharma, Rome, Italy
| | | | - Asli Goker
- Department of Obstetrics and Gynecology, Celal Bayar University, Manisa, Turkey
| | - Vittorio Unfer
- Department of Medical Sciences, UNIIPUS – Private Swiss University Institute, Chiasso, Switzerland
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Beigi A, Esmailzadeh A, Pirjani R. Comparison of Risk of Preterm Labor between Vaginal Progesterone and17-Alpha-Hydroxy-Progesterone Caproate in Women with Threatened Abortion: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:162-8. [PMID: 27441048 PMCID: PMC4948067 DOI: 10.22074/ijfs.2016.4905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/06/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Threatened miscarriage is a common complication in pregnancy that leads to adverse pregnancy outcomes such as preterm labor. This study aimed to compare the vaginal progesterone (Cyclogest) versus 17-alpha-hydroxyprogesterone caproate (Proluton) on preventing preterm labor in pregnant women with threatened abortion at less than 34 weeks' gestational age. MATERIALS AND METHODS This balanced randomized, double-blind, single-center controlled clinical trial included 190 women with threatened abortion. They were then randomly allocated into Cyclogest (n=95) and 17-alpha-hydroxyprogesterone caproate (Proluton, n=95) groups. Interested outcome was preterm labor less than 34 weeks. The Pearson chi-square and Student's t test were used to compare two groups. The data were analyzed by Stata software version 13. RESULTS The risks of preterm labor less than 34 weeks in Proluton and Cyclogest groups were 8.6 and 6.52%, respectively. There was no significant difference for risk of preterm labor less than 34 weeks [relative ratio (RR): 1.31, 95% confidence interval (CI): 0.47- 3.66, P=0.59] between two groups. CONCLUSION Risk of preterm labor in the vaginal progesterone group and 17-alpha-hydroxyprogesterone caproate group in pregnant women with threatened abortion is the same ( REGISTRATION NUMBER IRCT2014123120504N1).
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Affiliation(s)
- Abootaleb Beigi
- Department of Obstetrics and Gynecology, Arash Maternity Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Esmailzadeh
- Department of Obstetrics and Gynecology, Arash Maternity Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhane Pirjani
- Department of Obstetrics and Gynecology, Arash Maternity Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Nadarajah R, Rajesh H, Wong KY, Faisal F, Yu SL. Live birth rates and safety profile using dydrogesterone for luteal phase support in assisted reproductive techniques. Singapore Med J 2016; 58:294-297. [PMID: 27090598 DOI: 10.11622/smedj.2016080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Assisted reproductive techniques (ARTs) result in a deficient luteal phase, requiring the administration of intramuscular, intravaginal or oral exogenous progesterone. Dydrogesterone, an oral retroprogesterone with good bioavailability, has been used in assisted reproductive cycles with outcomes that are comparable to those of vaginal or intramuscular progesterone. However, there are limited reviews on its use for luteal phase support in ARTs, in terms of pregnancy outcomes and associated fetal anomalies. This study aimed to review the live birth rates and associated fetal anomalies of women who were given dydrogesterone for luteal phase support in assisted reproductive cycles at a tertiary hospital in Singapore. METHODS This retrospective descriptive study included 1,050 women who underwent in vitro fertilisation/intracytoplasmic sperm injection at the Centre for Assisted Reproduction of Singapore General Hospital between 2000 and 2011. The women were given dydrogesterone for luteal phase support. The main outcome measures were rates of pregnancy, live birth, miscarriage and fetal anomalies. RESULTS The pregnancy and live birth rates were 34.7% and 27.7%, respectively. Among those who achieved pregnancy, 17.0% miscarried, 0.8% had ectopic pregnancies and 0.3% had molar pregnancies. Fetal anomalies were detected in 1.9% of pregnancies, all of which were terminated by choice. CONCLUSION Since the outcomes of dydrogesterone are comparable to those of intramuscular and vaginal progesterone, it is a reasonable option to provide luteal phase support for women who are uncomfortable with injections or vaginal insertions. Randomised controlled studies are needed to determine the optimal dosage of dydrogesterone for luteal phase support in ARTs.
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Affiliation(s)
| | - Hemashree Rajesh
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Ker Yi Wong
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Fazlin Faisal
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Su Ling Yu
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
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12
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Abstract
Successful oocyte implantation and a favorable pregnancy outcome rely on optimal progesterone levels. Therefore, progesterone deficiencies associated with infertility and miscarriage have commonly been treated with progestogens that mimic the activity of progesterone. Among those is dydrogesterone, an oral retrosteroid with a structure closely related to that of progesterone yet with a greater bioavailability and higher selectivity for the progesterone receptor. This review describes the efficacy of dydrogesterone for the treatment of threatened and recurrent miscarriage, and infertility due to luteal phase insufficiency. Data from clinical trials evaluating dydrogesterone in assisted reproductive technology are also discussed. Prospective clinical trials, systematic reviews and meta-analyses have demonstrated that dydrogesterone significantly improves pregnancy outcomes in women with threatened miscarriage or with a history of miscarriage. Although this is not yet a registered indication, dydrogesterone was as effective as vaginal micronized progesterone for luteal phase support in the setting of assisted reproductive technology. The safety and tolerability of dydrogesterone treatment in pregnant women are also briefly addressed and the data support a well-established and favorable benefit-risk profile.
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Affiliation(s)
- Fadi Ghazi Mirza
- a American University of Beirut Medical Center, Department of Obstetrics and Gynecology , Beirut , Lebanon
| | - Ameet Patki
- b Fertility Associates , Mumbai , India , and
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13
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Abstract
The primary embryonic signal in primates is chorionic gonadotropin (CG, designated hCG in humans), that is classically associated with corpus luteum rescue and progesterone production. However, research over the past decade has revealed the presence of the hCG receptor in a variety of extragonadal tissues. Additionally, discoveries of the multiple variants of hCG, namely, native hCG, hyperglycosylated hCG (hyp-hCG) and the β- subunit of the hyperglycosylated hCG (hCG-free β) has established a role for extragonadal actions of hCG. For the initiation and maintenance of pregnancy, hCG mediates multiple placental, uterine and fetal functions. Some of these include development of syncytiotrophoblast cells, mitotic growth and differentiation of the endometrium, localized suppression of the maternal immune system, modulation of uterine morphology and gene expression and coordination of intricate signal transduction between the endometrium. Recurrent pregnancy loss, pre-eclampsia and endometriosis are associated with altered responses of hCG, all of which have a detrimental effect on pregnancy. A role for hyp-hCG in mediating the development of both trophoblastic and non-trophoblastic tumors has also been suggested. Other significant non-gonadal applications of hCG include predicting preeclampsia, determining the risk of Down's syndrome and gestational trophoblastic disease, along with relaxing myometrial contractility and preventing recurrent miscarriages. Presence of hCG free-β in serum of cancer patients enables its usage as a diagnostic tumor marker. Thus, the extragonadal functions of hCG encompasses a wide spectrum of applications and is an open area for continued investigation.
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Affiliation(s)
- Prajna Banerjee
- Department of Medicine/Oncology, Stanford University, Stanford, CA 94305, USA
| | - Asgerally T. Fazleabas
- Department of Obstetrics and Gynecology, and Reproductive Biology, College of Medicine, Michigan State University, Grand Rapids, MI 49503, USA
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