الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 114 |  |  |
| | | from | 114 | | |
Abstract
Preterm birth is the leading cause of perinatal morbidity and mortality, and its prevention is an important healthcare priority (Committee on Understanding Premature Birth and Assuring Healthy Outcomes, 2007)
Prematurity is the leading cause of neonatal death and handicap (Mathews TJ et al., 2000). Although all births before 37 weeks of gestation are defined as preterm, most damage and death occurs in infants delivered before 34 weeks, improvements in neonatal care have led to higher rates of survival among very premature infants, but a major effect on the associated mortality and morbidity will be achieved only by better identification of women at high risk for preterm delivery and by development of an effective intervention to prevent this complication (Marlow N et al., 2005).
The prophylactic administration of progesterone beginning in mid gestation to women who previously had a preterm birth has been shown to halve the rate of recurrence (Dodd JM et al., 2006). However, a strategy in which therapeutic intervention is limited to women with a previous preterm delivery is likely to have a small effect on the overall rate of prematurity, because only about 10% of spontaneous early preterm births occur in women with a history (Mercer BM et al., 1999).
This clinical trial was carried out on 100 pregnant women with preterm labor having a short cervix as proved by transvaginal ultrasound and who’s gestational ranged from 20 to 25 weeks of gestation, where 50 patients of them received vaginal progesterone (Prontogest 200 mg vaginal pessaries) every night from 22
weeks of gestation till 34 weeks, the other group received placebo.
Summary and conclusion
-70-
At the end of our study the following results occurred:
In progesterone group there is markedly reduced risk of preterm labor pain attacks throughout the study as compared to placebo group.
Marked improvement of maternal morbidity and neonatal outcome as regarding need for intermediate or intensive care incubator, neonatal respiratory distress, neonatal sepsis in progesterone group as compared to placebo group.
Cervical length changes throughout the study period hasn‘t significant changes and by comparison between the two groups P value was >0.1 this means that progesterone has no role in increasing cervical length in patients with short cervix as predictor of preterm labor.
Marked improvement in maternal outcome as regarding inhibition of labor pains and preterm labor attacks also continuation of pregnancy up to and beyond 34 weeks of gestation in Progesterone group as compared to placebo group, total number of patients was 50 patients, those who continued pregnancy beyond 34 weeks were 18 patients giving a percentage of 36% of the total number, no patient experienced progesterone failure (i.e. the patient experienced true preterm labor, gush of fluid or severe colicky lower abdominal pain leading to changing line of treatment to an effective method) ; while patients who delivered around 34 weeks were 32 patients giving a percentage of 64% of the total number.
While In placebo group to total number of patients was 50 patients, those who continued pregnancy beyond 34 weeks were 7 patients giving a percentage of 14% of the total number, patients who experienced progesterone failure (i.e. the patient experienced true preterm labor, gush of
Summary and conclusion
-71-
fluid or severe colicky lower abdominal pain leading to changing line of treatment to an effective method) was 20 patients giving a percentage of 40% ; while patients who delivered around 34 weeks were 23 patients giving a percentage of 46% of the total number( p <0.005, highly significant).
There was marked improvement in neonatal outcome in progesterone group as compared to placebo group, the total number of patients was 50 patients, those who delivered at 34 weeks with good neonatal outcome as regarding fetal distress, need for neonatal intermediate or intensive care incubator or ventilator, intracerebral hemorrhage were 24 patients with a percentage of 48% of the total number; but those who delivered babies with adverse neonatal outcome as regarding fetal distress, need for neonatal intermediate or intensive care incubator or ventilator, intracerebral hemorrhage were 8 patients with a percentage of 16% of the total number
where in placebo group total number of patients was 50 patients, those who delivered babies with good neonatal outcome as regarding fetal distress, need for neonatal intermediate or intensive care incubator or ventilator, intracerebral hemorrhage were 7 patients with a percentage of 14 % of the total number; but those who delivered babies with adverse neonatal outcome as regarding fetal distress, need for neonatal intermediate or intensive care incubator or ventilator, low birth weight preterm infant or intracerebral hemorrhage were 16bpatients with a percentage of 32 % of the total number, the p value was 0.001 (statistically highly significant).