Effectiveness of dydrogesterone, 17-OH progesterone and micronized progesterone in prevention of preterm birth in women with a short cervix

Objective: To compare the efficacy of dydrogesterone, 17-OH progesterone (17OHP) and oral or vaginal micronized progesterone with cerclage for the prevention of preterm birth in women with a short cervix. Methods: The study included 95 women with singleton gestation and cervical length (CL) ≤ 25 mm. Among these, 35 women were asymptomatic at 15–24 weeks and 60 had symptoms of threatened late miscarriage (LM) or preterm delivery (PD) at 15–32 weeks. Patients were randomized to receive dydrogesterone, 17OHP or oral/vaginal micronized progesterone; after one week of therapy 15 women underwent cerclage. Results: Efficacy of vaginal progesterone (VP) for the prevention of preterm birth reached 94.1%. In asymptomatic women pregnancy outcomes were comparable to cerclage. In women with threatened LM/PD, combination therapy with VP, indomethacin and treatment of bacterial vaginosis (BV) with the subsequent use VP until 36 weeks together with CL monitoring significantly decreased the rate of preterm birth (RR 0.01; 0.0001–0.24) and low birth weight (LBW) (RR 0.04; 0.01–0.96). CL increase during the first week of treatment with a subsequent plateau phase indicated treatment efficacy. Dydrogesterone, 17OHP, and micronized oral progesterone (OP) were associated with PD in 91.7% of women. Conclusions: Combination management strategy including VP significantly benefits pregnancy outcomes in women with a short cervix compared with cerclage. Dydrogesterone, 17OHP, and OP were not found to be efficacious. © 2017 Informa UK Limited, trading as Taylor & Francis Group

Management of mastitis and breast engorgement in breastfeeding women

Objective: To identify the best management approaches to mastitis management in breastfeeding women and heavy breast engorgement in the early postnatal period. Methods: We compared various international guidelines and reviews on mastitis management in breastfeeding women and breast engorgement treatment. Results: Effective milk removal is recommended as a first step in mastitis management. Active emptying of the breasts can prevent mastitis development in most cases. If it fails, antibiotics should be administered for 10–14 days with continuing breastfeeding. Russian guidelines recommend antibiotic therapy during 5–7 days with temporary bromocriptine-induced breastfeeding suppression. In case of heavy breast engorgement after lactation is initiated, Progesterone-containing gel can be administered. Application of the progesterone-containing gel on the breast skin improves swelling, and reduces engorgement and tenderness in 15–20 minutes. Conclusions: Antibiotics with temporary suppression of breastfeeding are more effective than with continuing breastfeeding in mastitis management. The progesterone-containing gel is recommended on the 3rd–4th days after childbirth in heavy breast engorgement to prevent mastitis. © 2015 Taylor & Francis

Progestin-only implant contraception (a review of global clinical guidelines)

The article reviews global clinical recommendations for progestin-only implant contraception. The efficacy, safety, risks and side effects of subdermal implants Implanon and Implanon NXT are described

PRECONCEPTION PREPARATION

The article provides major provisions of the preconception preparation. The practicability of diagnostic and therapeutic and preventive measures at preparation to pregnancy as well as the role of the family planning in prevention of obstetrical and perinatal complications is justified

Asymptomatic bacteriuria in pregnancy: what evidence-based medicine says

The article is a review of literature and the current global and national recommendations for the management of pregnant women with asymptomatic bacteriuria (AB). The main agents of AB and recommended regimens of antibiotic therapy are described. The efficacy of fosfomycin trometamol as first-line therapy for pregnant women with AB is demonstrated

Achievements and risks of folate use during and not in pregnancy

90% of the population have folate deficiency, which is associated with both inadequate intake of folate-containing food and impaired function of the folate cycle enzymes. Due to a high prevalence among the population of genetic polymorphisms of the folate cycle enzymes, the use of a multivitamin-mineral complex containing folates in a biologically active form is pathogenetically justified

Management of mastitis and breast engorgement in breastfeeding women

Objective: To identify the best management approaches to mastitis management in breastfeeding women and heavy breast engorgement in the early postnatal period. Methods: We compared various international guidelines and reviews on mastitis management in breastfeeding women and breast engorgement treatment. Results: Effective milk removal is recommended as a first step in mastitis management. Active emptying of the breasts can prevent mastitis development in most cases. If it fails, antibiotics should be administered for 10–14 days with continuing breastfeeding. Russian guidelines recommend antibiotic therapy during 5–7 days with temporary bromocriptine-induced breastfeeding suppression. In case of heavy breast engorgement after lactation is initiated, Progesterone-containing gel can be administered. Application of the progesterone-containing gel on the breast skin improves swelling, and reduces engorgement and tenderness in 15–20 minutes. Conclusions: Antibiotics with temporary suppression of breastfeeding are more effective than with continuing breastfeeding in mastitis management. The progesterone-containing gel is recommended on the 3rd–4th days after childbirth in heavy breast engorgement to prevent mastitis. © 2015 Taylor & Francis

Effectiveness of dydrogesterone, 17-OH progesterone and micronized progesterone in prevention of preterm birth in women with a short cervix

Objective: To compare the efficacy of dydrogesterone, 17-OH progesterone (17OHP) and oral or vaginal micronized progesterone with cerclage for the prevention of preterm birth in women with a short cervix. Methods: The study included 95 women with singleton gestation and cervical length (CL) ≤ 25 mm. Among these, 35 women were asymptomatic at 15–24 weeks and 60 had symptoms of threatened late miscarriage (LM) or preterm delivery (PD) at 15–32 weeks. Patients were randomized to receive dydrogesterone, 17OHP or oral/vaginal micronized progesterone; after one week of therapy 15 women underwent cerclage. Results: Efficacy of vaginal progesterone (VP) for the prevention of preterm birth reached 94.1%. In asymptomatic women pregnancy outcomes were comparable to cerclage. In women with threatened LM/PD, combination therapy with VP, indomethacin and treatment of bacterial vaginosis (BV) with the subsequent use VP until 36 weeks together with CL monitoring significantly decreased the rate of preterm birth (RR 0.01; 0.0001–0.24) and low birth weight (LBW) (RR 0.04; 0.01–0.96). CL increase during the first week of treatment with a subsequent plateau phase indicated treatment efficacy. Dydrogesterone, 17OHP, and micronized oral progesterone (OP) were associated with PD in 91.7% of women. Conclusions: Combination management strategy including VP significantly benefits pregnancy outcomes in women with a short cervix compared with cerclage. Dydrogesterone, 17OHP, and OP were not found to be efficacious. © 2017 Informa UK Limited, trading as Taylor & Francis Group

Effects of antibiotic therapy in women with the amniotic fluid “sludge” at 15–24 weeks of gestation on pregnancy outcomes

Objective: The aim of this prospective study was to assess the efficacy of antibiotic therapy for the prevention of adverse pregnancy outcomes in women with the amniotic fluid “sludge” at 15–24 weeks of gestation. Methods: 245 women underwent transvaginal ultrasound cervical length measurement at 15–24 weeks of pregnancy and 29 out of them with amniotic fluid “sludge” were included in the study. Eight women with the “sludge” had cervical length >25 mm (Group I), seven—an asymptomatic short cervix (Group IIa) and 14 women with a short cervix had symptoms like low abdominal pain, back pain, and menstrual-like cramps (Group IIb). All participants received intravenous, oral and/or vaginal antibiotic therapy. Participants in Group IIa were additionally given vaginal progesterone (VP), and in Group IIb—VP and indomethacin. Placentas from women with preterm birth (PTB) underwent histological examination. Results: The amniotic fluid “sludge” detected at an ultrasound scan between 15–24 weeks of gestation was associated with long-term maternal infections, histological chorioamnionitis, and was viewed as a marker of intra-amniotic infection. Absence of intravenous antibiotic therapy during midtrimester of pregnancy in these women was associated with neonatal infection with intrauterine onset in 61.1%, postpartum endometritis in 23.1%, and rate of PTB 46.2%. Intravenous antibiotic therapy eliminated sonographic presence of the sludge and resulted in prevented of neonatal and postpartum infections, prevented the risk of PTB in women with the cervical length >25 mm, in those with an asymptomatic short cervix receiving VP, and in 70% of symptomatic women with a short cervix, who received them in combination VP/indomethacin. For those women whose approach was not fully beneficial, it allowed to delay delivery in 11–17 weeks. Conclusions: Although we found that intravenous antibiotic therapy at 15–24 weeks of gestation in women with amniotic fluid “sludge” can protect from infection-related complications and demonstrated high beneficial effects of adding antibiotics to anti-inflammatory drug (indomethacin) and/or VP in women with a short cervix, further larger studies are needed. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group