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The problem of miscarriage in multiple pregnancy.
Volodymyr I Boiko1, Irina M Nikitina1, Tetyana V Babar1
1Sumy State University, Sumy, Ukraine.
Wiadomosci Lekarskie (Warsaw, Poland : 1960)
|November 19, 2018
Summary
Combining obstetric pessaries with micronized progesterone effectively prevents miscarriage in multiple pregnancies. This approach reduces complications and improves perinatal outcomes, offering a promising treatment for high-risk pregnancies.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Perinatology
Background:
- Multiple pregnancies are at high risk for miscarriage and preterm birth.
- Current treatments for threatened miscarriage in multiple pregnancies have varying success rates.
- Cervical incompetence is a significant factor in pregnancy loss.
Purpose of the Study:
- To evaluate the effectiveness of using an obstetric pessary combined with micronized progesterone for preventing miscarriage in women with multiple pregnancies.
- To assess the impact of this combined treatment on clinical symptoms, ultrasound markers, complications, and hospital stay duration.
Main Methods:
- A comparative study involving 120 women with multiple pregnancies (twins) between 16-28 weeks gestation presenting with signs of miscarriage.
- Group I (n=40): Obstetric pessary + continuous micronized progesterone until 36 weeks.
- Group II (n=40): Cervical cerclage + short-term gestagen therapy.
- Control Group (n=40): Standard miscarriage treatment per Ukrainian Ministry of Health protocols.
- Analysis included pregnancy course, childbirth, postpartum period, and neonatal adaptation.
Main Results:
- The combined pessary and progesterone group (Group I) showed a higher rate of prolonged pregnancy compared to the control group (62.5% vs. 25% urgent childbirth).
- Cesarean delivery rates were lower in Group I (17.5%) compared to Group II (22.5%) and the control group (27.5%).
- Neonatal outcomes, including average birth weight and Apgar scores, were comparable across all groups, with no statistically significant differences (p>0.05).
Conclusions:
- The combination of an obstetric unloading pessary and micronized progesterone is an effective method for preventing miscarriage in multiple pregnancies.
- This comprehensive prophylaxis helps prolong pregnancy, reduce prematurity, and improve perinatal indicators.
- The treatment demonstrates potential for enhancing outcomes in high-risk multiple gestations.
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