Progesterone as therapy or prophylaxis in pregnancy

master's thesis

• Title (croatian): Terapijsko ili zaštitno djelovanje progesterona u trudnoći
• Author: Ann Sofia Sundin
• Mentor: Maja Banović (mentor)
• Committee member: Držislav Kalafatić (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Maja Banović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

BACKGROUND AND AIMS: fecundability of humans is quite low compared to the majority of other species and further impairment of fertility has been noticed in recent decades. An estimated twenty percent of pregnancies miscarry. Early and late pregnancy loss leaves great emotional stress and burdens both partners with a lot of unanswered questions. Preterm birth (PTB), defined as a delivery of a live born infant before 37 weeks or 259 days of pregnancy complicates a bit over 12% of all US deliveries and it is one of main causes of neonatal morbidity and mortality. Therefore it is clear that there is a need for further research to discover a successful treatment to these conditions. Since progesterone is the essential pregnancy hormone, various randomized controlled studies have been made with the aim to bring clarity to wether or not the supplementation of progesterone really is effective in improving the pregnancy outcome when used as a treatment for threatened miscarriage and/or preterm delivery. The aim of this paper is to present a comprehensive review of literature on the effects of progesterone supplementation in pregnancy. With ambiguous results of research so far, a better understanding of progesterone’s role in pregnancy is being sought for. ----- METHODS: PubMed, Cochrane Library and Google scholar were primary sources for finding relevant material. Search was limited to English articles and terms included were: progesterone in pregnancy; recurrent miscarriage; recurrent pregnancy loss; preterm delivery; habitual abortions and therapy. The main criteria in the selection process was to find a good selection of published evidence-based research as well as avoiding outdated articles. ----- FINDINGS: There is still inconsistency of results regarding progesterone’s role as therapy or prophylaxis in pregnancy with results from two of the newest and largest studies contradicting each other. It is therefore still questionable whether or not progesterone should still be recommended as therapy or prophylaxis in pregnancy and which of the factors are of the greatest value when estimating the possible outcome of its use. Further research with larger groups is needed.

Abstract (english)

POZADINA I CILJEVI: Dvadeset posto trudnoća završi pobačajem. Gubitak trudnoće ima negativne posljedice za emotivno stanje žene a također ostavlja brojna neodgovorena pitanja o njihovom fizičkom oporavku. U razvijenim zemljama prijevremeni porođaj komplicira oko 12% porođaja i definira se kao rođenje djeteta prije 37. tjedna ili 259 dana trudnoće. Prijevremeni porođaj predstavlja značajan rizik za neonatalni morbiditet i mortalitet. Još uvijek ne postoji jasno definiran terapijski pristup za liječenje ili sprječavanje prijevremenog porođaja. Obzirom da je progesteron esencijalni hormon trudnoće, brojna istraživanja i meta-analize su učinjene kako bi se definiralo je li nadomjesno liječenje ovim hormonom zbilja učinkovito u poboljšanju ishoda prijetećeg pobačaja i/ili prijevremenog porođaja. Obzirom na oprečne rezultate dosadašnjih istraživanja traži se bolje razumijevanje uloge progesterona u trudnoći. Cilj ovog rada je sveobuhvatni pregled literature o učincima progesterona u trudnoći i učincima nadomjesne progesteronske terapije. ----- METODE: Analizirani članci nađeni su pretraživanjem baza PubMed, Cochrane Library i Google scholar. Svi članci koji su uzeti u obzir bili su na engleskom jeziku. Pojmovi koji su korišteni kod pretraživanja su: progesteron u trudnoći, rani gubitak trudnoće, ponavljajući spontani pobačaj, prijevremeni porođaj, habitualni pobačaj i terapija. Glavni kriteriji pri odabiru radova koji su uključeni u analizu bilo je pronalaženje članaka temeljenih na znanstvenim istraživanjima i dokazima, kao i izbjegavanje zastarjelih članaka. ----- ZAKLJUČAK: Još uvijek postoje nedosljednosti u pogledu uloge progesterona kao terapije ili profilakse u trudnoći. Rezultati najnovijih i najvećih studija su proturječni. Stoga, još uvijek nije jasno definirana terapijska ili profilaktična uloga progesterona u trudnoći, te koji čimbenici imaju najveću vrijednost kod procjene mogućeg ishoda njegove uporabe. Potrebna su daljnja istraživanja s većim skupinama.

• Keywords: progesterone; miscarriage; preterm delivery; habitual abortions
• Keywords (english): progesteron; spontani pobačaj; habitualni pobačaji; prijevremeni porođaj
• Language: english
• URN:NBN: urn:nbn:hr:105:749109
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Repository: Dr Med - University of Zagreb School of Medicine Digital Repository
• Created on: 2019-04-23 09:47:35