17 Alpha Hydroxyprogesterone Caproate (17OHPC) vs Nifedipine as a Maintenance Tocolytic after Arrested Preterm Labor | Chapter 1 | Medical Research and Its Applications Vol. 2

 

Background: Preterm birth remains a major cause of concern in obstetrics. It can result in poor neonatal outcomes in neonates because of various complications of prematurity like intraventricular hemorhage, necrotizing enterocolitis, respiratory distress, sepsis, severe neurological deficit and neonatal death. For decades, progesterone has been studied in different preparations and doses to decrease preterm delivery, especially in those with high-risk factors like multiple pregnancies, short cervix, prior preterm deliveries etc. 17 alpha hydroxyprogesterone caproate is a synthetic derivative of 17 alpha hydroxyprogesterone, that has shown to reduce recurrent preterm birth before 37 weeks. This study was done to evaluate the efficacy of 17 alpha hydroxyprogesterone caproate, in preventing preterm delivery after acute tocolysis with nifedipine in patients with preterm labor irrespective of the risk factors for preterm delivery.

Material and Methods: It was a prospective clinical trial that was carried out on 100 pregnant females between 28-34 weeks of gestation diagnosed with preterm labor. All patients in preterm labor were given nifedipine for acute tocolysis and antenatal corticosteroid was given to all patient for lung maturity. After tocolysis, undelivered patients were randomly allocated to case (n=50) and control group (n=50). Patients in case group were given 17 alpha hydroxyprogesterone caproate,250 mg, through intramuscular route, weekly and continued till 36 weeks of gestation or delivery, which ever occurred earlier. Patients in control group were given nifedipine as a maintenance tocolytic as and when required. Results were analyzed in terms of gestational age at delivery and neonatal outcome in both groups.

Results and Discussion: The mean gestational age at delivery was 35.2±2.3 weeks in the case group and 35.4±2.6 weeks in the control group. It was statistically similar in the two groups. Neonatal outcome was also found to be statistically similar in both groups.

Conclusion: This study suggests that patients with preterm labor, arrested by tocolytics can be given 17 alpha hydroxy progesterone caproate as a maintenance tocolytic as a suitable alternative to nifedipine.

 

Author(s)details:-

 

Asma Nigar
Department of OBGY Integral Institute of Medical Sciences and Research, Lucknow, India

 

Seema Hakim
Department of OBGY, Jawahar Lal Nehru Medical College, AMU, Aligarh, India.

 

Zehra Mohsin
Department of OBGY, Jawahar Lal Nehru Medical College, AMU, Aligarh, India.

 

Please See the book here :-  https://doi.org/10.9734/bpi/mria/v2/7927E

Determining the Role of Pregnancy-associated Plasma Protein-A Level in the First Trimester of Pregnancy and Clinical Outcome in an Urban Referral Centre, South India | Chapter 13 | Highlights on Medicine and Medical Science Vol. 13

 Introduction: Screening for aneuploidy in the first trimester, which includes nuchal translucency (NT), pregnancy-associated plasma protein-A (PAPP-A), and free-beta subunit human chorionicgonadotrophin (fhCG), has become a standard element of prenatal care. Estimating serum PAPP-A levels has also been extensively researched in terms of other prediction factors for unfavourable neonatal outcomes. This case-control study also aims to determine if there is a link between low PAPP-A levels in pregnant women and a poor maternal foetal outcome.

Objectives:

The primary goal of this study was to see if a low PAPP-A level in the first trimester of pregnancy was linked to poor mother and foetal outcomes.

Secondary goal: Determine the predictive significance of a low PAPP-A level in predicting negative perinatal outcomes.

Methods: This is a case-control study of women delivered at Mehta Multispecialty Hospitals India Pvt. Ltd.'s Department of OBG between August 2017 and May 2018. Women who underwent a PAPP-A level screening in the first trimester gave birth in the labour room. After receiving informed consent (Annexure II & III), the study was explained to the participants, and a questionnaire with full prenatal history, birth mode, and infant data was input into Annexure II. The subjects are divided into case and control groups depending on the outcome. Out of the 264 people in the study, 88 patients with complications were designated as cases, while 176 patients with no issues were designated as controls, and both the case and control group studies were conducted.

The study found no statistically significant link between the case and control groups for characteristics such as maternal age, parity, marital history, family history, and previous obstetric difficulty.

Mode of conception (ART, IUI, Ovulation induction) represented substantially larger number in the case group compared to the control group, which was statistically shown (p 0.05).

In the case group, 78 percent of the babies were born at 37 weeks, whereas only 18 percent were born at term, a statistically significant difference from the control group.

In our study, the most common complications were PIH and Pre-Eclampsia (17%), Preterm (9.1%), and IUGR (6.8%), with normal outcomes in 66.7 percent.

In our study, the LSCS rate was higher than the normal delivery rate out of 264 deliveries. Normal deliveries account for 28% of all deliveries, while LSCS deliveries account for more than 72%.

In our research, low PAPP-A levels (0.5MoM) are associated with a higher risk of PIH and Preeclampsia, followed by IUGR and Preterm birth. When PAPP-A levels are greater than 0.5MoM, the normal outcome outweighs the unfavourable outcome. PAPP-A levels varied by a statistically significant amount.

Low birth weight was observed to be statistically significant in women with a low PAPP A level as compared to those with a 0.5 PAPP A level. The relationship between NICU admission and APGAR was not found to be statistically significant. LBW newborns have a significant prevalence of low PAPP A levels.

PAPP A levels had a sensitivity of 17.04 percent and a specificity of 98.85 percent in identifying difficult outcomes in the current investigation. Predicting complications had a positive predictive value of 88.23 percent and a negative predictive value of 70.44 percent.

Conclusion: Based on the findings of the above study, low PAPP-A levels detected during the first trimester of pregnancy are linked to unfavourable maternal and foetal outcomes such as PIH, preeclampsia, preterm birth, IUGR, and LBW. As a result, anytime an obstetrician encounters a patient with low PAPP-A levels, he or she should be cautious and vigilant, which can also assist with self-preparation.

Author (S) Details

T. Lavanya
Pranav Speciality Clinic & SLP Scan Center, Urapakkam, Chennai, India.

Nandita A. Thakkar
Dept. of OBG Dr. Mehtas Multi Speciality Hospitals, Chetpet. Chennai, India.

R. Premalatha
Dept. of OBG Dr. Mehtas Multi Speciality Hospitals, Chetpet. Chennai, India.

View Book :- https://stm.bookpi.org/HMMS-V13/article/view/2732