Maternal and Fetal Doppler Blood Flow Velocimetry Changes in the Management of Asymptomatic Preterm Labor With Vaginal Progesterone Tablet

  • Shirin Niromanesh Department of Obstetrics and Gynecology, Moheb Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Sahar Farzin Moghadam Mail Department of Obstetrics and Gynecology, Moheb Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Fatemeh Rahimi Sherbaf Department of Obstetrics and Gynecology, Moheb Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Doppler ultrasonography, Blood flow, Velocimetry, Asymptomatic preterm labor, Vaginal progesterone tablet

Abstract

Doppler sonography has been used for evaluation of different fetal responses to various drugs on doppler blood flow patterns in fetal circulation that may indicate poor fetal prognosis. To assess the uterine and fetal doppler blood flow velocimetry changes in the management of asymptomatic preterm labor with vaginal progesterone tablet, it is found that using a vaginal tablet of progesterone affects uterine, umbilical and fetal middle cerebral arteries in the second and third trimesters of pregnancy. This prospective Case series (uncontrolled longitudinal study) was conducted in an outpatient clinic and emergency unit in Moheb Yas hospital during 2015-2016. For all subjects, 200 mg vaginal progesterone tablet (one tablet before bedtime) was administered. Additionally, transvaginal Doppler sonography was performed to measure uterus, umbilical, and middle cerebral arteries before the treatment with progesterone and 24 hours after the treatment with that, respectively. The mean gestational age of participants was 28.8±2.9 weeks, ranging from 23 to 32 weeks of gestation. There was no significant change in the fetal middle cerebral artery-peak systolic velocity (MCA-PSV), middle cerebral artery resistance index (MCA-RI), MCA-PI, Umbilical arterial  Systolic-Diastolic (UA S/D), Right UtA-RI and Left UtA-RI before the beginning of progesterone treatment to 24 hours after. The current study indicated that the 200 mg vaginal tablet of progesterone for treatment of preterm labor leads to a reduction in the middle cerebral artery and the uterine artery PI and RI and an increase in umbilical artery S/D, respectively. Vaginal progesterone can improve fetoplacental perfusion in pregnancies complicated by preterm labor. This a preliminary result from a case series study and it has to be confirmed by a randomized clinical trial in future.

References

Edmund F Funai. Patient education: Preterm labor (Beyond the Basics). uptodate. May 24, 2017.

Hamilton BE, Minino AM, Martin JA, et al. Annual summary of vital statistics: 2005.Pediatrics 2007;119:345–60.

Steer P. The epidemiology of preterm labor. BJOG 2005;112:1–3.

National Center for Health Statics (NVSR). Deaths and percentage of total deaths for the 10 leading causes of neonatal and postnatal deaths: United States; 2001 [accessed 07.02.05].

Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008;371:75–84.

Moster D, Lie RT, Markestad T. Long-term medical and social consequences of preterm birth. N Engl J Med 2008;359: 262–73.

O’Brien JM, Adair CD, Lewis DF, et al. Progesterone vaginal gel for the reduction of recurrent preterm birth: primary results from a randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 2007;30: 687–96.

Barda, G., Ben-Haroush, A., Barkat, J., et al. Effect of vaginal progesterone, administered to prevent preterm birth, on impedance to blood flow in fetal and uterine circulation. Ultrasound in Obstetrics & Gynecology,2010; 36(6): 743-8.

Dodd, J., Jones, L., Flenady, V., Cincotta, R., Crowther, C. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane Database Syst Rev, 2012; 7: CD004947.

Di Renzo, G. C., Giardina, I., Clerici, G., et al. The role of progesterone in maternal and fetal medicine. Gynecological Endocrinology, 2012; 28(11): 925-32.

Stites DP, Siiteri PK. Steroids as immunosuppressants in pregnancy. Immunol Rev 1983;75:117–38.

Romero R. Prevention of spontaneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment. Ultrasound Obstet Gynecol 2007;30:675–86.

Challis JRG, Lye SJ. The physiology of reproduction. In: Knobil E, Neill JD, editors. Parturition. New York: Raven Press; 1994. p. 985–1031.

Deichert U, Albrand-Thielmann C, van de Sandt M. Dopplersonographic pelvic blood flow measurements and their prognostic value in terms of luteal phase and implantation. Hum Reprod 1996; 11: 1591–1593.

Czajkowski K, Sienko J, Mogilinski M, et al. Utroplacental circulation in early pregnancy complicated by threatened abortion supplemented with vaginal micronized progesterone or oral dydrogesterone. Fertil Steril 2007; 87: 613–618.

Habara T, Nakatsuka M, Konishi H, et al. Elevated blood flow resistance in uterine arteries of women with unexplained recurrent pregnancy loss. Hum Reprod 2002; 17: 190–194.

Hassan SS, Romero R, Vidyadhari D, et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol. 2011 Jul;38(1):18-31.

Cicinelli E., de Ziegler D., Bulletti C., et al. Direct transport of progesterone from vagina to uterus. Obstetrics & Gynecology,2000; 95(3): 403-6.

Fanchin R., de Ziegler D., Bergeron C., et al. Transvaginal administration of progesterone. Obstetrics & Gynecology, 1997; 90(3): 396-401.

Meis JM, Klebanoff M, Thorn E, et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 2003; 348: 2379–2385.

Da Fonseca EB, Bittar RE, Carvalho MHB, Zugaib M. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: A randomized placebo-controlled double-blind study. Am J Obstet Gynecol 2003; 188: 419–424.

O’Brien JM, Adair CD, Lewis DF, et al. Progesterone vaginal gel for the reduction of recurrent preterm birth: primary results from a randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol 2007; 30: 687–696.

Fonseca EB, Celik E, Parra M, Singh M, Nicolaides KH. Progesterone and risk of preterm birth among women with a short cervix. N Engl JMed 2007; 357: 462–469.

DeFranco EA, O’Brien JM, Adair CD, et al. Vaginal progesterone is associated with a decrease in risk for early preterm birth and improved neonatal outcome in women with short cervix: a secondary analysis from a randomized, doubleblind, placebo-controlled trial. Ultrasound Obstet Gynecol 2007; 30: 697–705.

Khandelwal, M. Vaginal progesterone in risk reduction of preterm birth in women with short cervix in the midtrimester of pregnancy. International journal of women's health,2012; 4: 481.

Farine D, Mundle WR, Dodd J. The use of progesterone for prevention of preterm birth. J Obstet Gynaecol Can 2008;30(1):67–71.

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. American journal of obstetrics and gynecology, 206(2),2012; 124: e1-e19.

Martinez R., Figueras F. The role of Doppler and placental screening. Best Practice & Research Clinical Obstetrics & Gynaecology, 2009;23(6): 845-55.

Garc´ıa-Velasco JA, Gonz´ alez Gonz´ alez A. A prospective, randomized trial of nifedipine vs. ritodrine in threatened preterm labor. Int J Gynaecol Obstet 1998; 61: 239–244.

Economy KE, Abuhamad AZ. Calcium channel blockers as tocolytics. Semin Perinatol 2001; 25: 264–271.

Li HF, Zheng TZ, Li W, Qu SY, Zhang CL. Effect of progesterone on the contractile response of isolated pulmonary artery in rabbits. Can J Physiol Pharmacol. 2001;79(6):545–50.

Hermenegildo C, Oviedo PJ, Garcia-Martinez MC, et al. Progestogens stimulate prostacyclin production by human endothelial cells. Hum Reprod. 2005;20(6):1554–61.

Omar HA, Ramirez R, Gibson M. Properties of a progesterone-induced relaxation in human placental arteries and veins. J Clin Endocrinol Metab. 1995;80(2):370–3.

DeFranco E.A, DeArmond CH, Van Hook J. Progesterone administration for the prevention of preterm birth: effect on uterine blood flow dynamics. Supplement to JANUARY 2016 American Journal of Obstetrics & Gynecology, S293.

Borna S, Borna H, Gotbizadeh F, Jahani M. Evaluation of Progesterone Effects on Fetal Doppler Velocimetry. Obstet Gynecol Cancer Res. 2016 November; 1(3):e9399.

Bar J., Lahav J., Hod M., et al. Regulation of platelet aggregation and adenosine triphosphate release in vitro by 17beta-estradiol and medroxyprogesterone acetate in postmenopausal women. Thrombosis and haemostasis, 2000 ;84(4): 695-700.

Mäkikallio K., Tekay A., Jouppila P. Uteroplacental hemodynamics during early human pregnancy: a longitudinal study. Gynecologic and obstetric investigation, 2004;58(1): 49-54.

Borna S. Progesterone effect on fetal Doppler velocimetry in pregnant women with IUGR and preterm labour. Ultrasound in Obstetrics & Gynecology,2014; 44(S1): 265-266.

Published
2018-06-23
How to Cite
1.
Niromanesh S, Farzin Moghadam S, Rahimi Sherbaf F. Maternal and Fetal Doppler Blood Flow Velocimetry Changes in the Management of Asymptomatic Preterm Labor With Vaginal Progesterone Tablet. Acta Med Iran. 56(6):398-404.
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Articles