Prijava na doktor.rs mailing listu
Pratite nas redovno putem newslettera.

Sva vremena su u UTC + 2 sata




Započni novu temu Odgovori na temu  [ 9 Posta ] 
Autoru Poruka
 Tema posta: O PROGESTERONU NAJNOVIJA SAZNANJA
PostPoslato: Sre Feb 21, 2007 11:56 pm 
OffLine
Stalni član
Stalni član

Pridružio se: Sre Jan 12, 2005 12:01 am
Postovi: 1058
Lokacija: Beograd
High-Dose Hydroxyprogesterone Stops Preterm Delivery Through Anti-Inflammatory Effects


Martha Kerr
Medscape Medical News 2007. © 2007 Medscape




February 15, 2007 (San Francisco) — High-dose 17-alpha hydroxyprogesterone in women at risk for preterm labor effectively prevents preterm delivery by inhibiting cervical ripening and by blocking interleukin 1 (IL-1) secretion.

A study with these results received an award from the March of Dimes for research into the prevention of prematurity and was presented here during the 27th annual meeting of the Society for Maternal-Fetal Medicine (SMFM).

"This study gives us for the first time a look at the mechanism by which progesterone prevents preterm birth," SMFM chairwoman Nancy Chescheir, MD, chair of the Department of Obstetrics and Gynecology at Vanderbilt University in Nashville, Tennessee, said in an interview with Medscape.

Fabio Facchinetti, MD, from the Universita di Modena e Reggio Emilia in Modena, Italy, presented meeting attendees with the study of 45 women, hospitalized and remaining undelivered after an episode of preterm labor that occurred between 25 and 33 weeks' gestation.

Women were randomized to observation (22 women) or to 341 mg of 17-alpha hydroxyprogesterone caproate intramuscularly twice a week until 36 weeks' gestation (23 women). At 7 and 21 days posttreatment, researchers collected cervical secretions and performed ultrasound to assess cervical length.

Cervical secretions were analyzed for an array of inflammatory factors, including IL-1, IL-6, IL-8, tumor necrosis factor-alpha, and immunoassays for nitrates and nitric oxide enzyme levels were performed.

Dr. Facchinetti reported that there was progressive cervical shortening in the observation group, while cervical length was significantly longer in the hydroxyprogesterone group. IL-1 levels remained stable in the observation group but were significantly lower in the treatment group during follow-up. IL-1 was the only inflammatory factor that was affected by 17-alpha hydroxyprogesterone treatment, Dr. Facchinetti emphasized.

Five women (21.7%) delivered prematurely in the treatment group compared with 12 women (54.5%) in the observation group.

"There were some worries that high-dose progesterone might have [an adverse effect] on the fetus, but in other studies with 4-year follow-up, there was absolutely no effect," Dr. Fachinetti told Medscape.

"17-alpha hydroxyprogsterone is an anti-inflammatory agent. It appears to act by blocking cervical ripening and preventing cervical shortening," the Italian investigator speculated. "The next step is to get a grant to study multiple women to see if hydroxyprogesterone blocks cervical ripening," he said.

"It is premature to use this in clinical practice yet," Dr. Facchinetti cautioned. "Hydoxyprogesterone is used now for women with a history of preterm birth. We need to perform large randomized trials first before we know if it should be used for women during their first pregnancy with a risk of preterm birth."

Dr. Facchinetti's study was independently funded. Dr. Chescheir reports no relevant financial relationships.

SMFM 27th Annual Meeting: Oral Concurrent Session 1, Abstract 9. Presented February 8, 2007.

A MI TO U SRBIJI ZNAMO ODAVNO, BAR PO KOLIČINI PROPISANOG PROGESTERONA!!!

Pozdrav Dr PeđaDj


Vrh
 Profil  
 
 Tema posta: Re: O PROGESTERONU NAJNOVIJA SAZNANJA
PostPoslato: Čet Feb 22, 2007 12:13 am 
OffLine
Aktivan član
Aktivan član

Pridružio se: Čet Feb 01, 2007 12:48 am
Postovi: 472
PedjaDj je napisao:
A MI TO U SRBIJI ZNAMO ODAVNO, BAR PO KOLIČINI PROPISANOG PROGESTERONA!!!

Pozdrav Dr PeđaDj


Dragi Dr PeđaDj,

Ova tema me je jako zainteresovala ali od svega što ste napisali ja sam razumela samo ovo što sto sam citirala iz celog texta!!!

Kada sam se učlanjivala na ovaj forum bila mi je ponuđena opcija da izaberam jezik na kome želim da čitam poruke, kao i svima nama.
Mogla sam da izaberam engleski ali naravno nisam, pa sam izabrala srpski.
Verovatno neke žene sa ovog foruma znaju odlično engleski jezik, možda su neke i profesori engleskog pa im neće biti problem da ovo pročitaju ali sam sigurna da većina kao i ja ne zna toliko dobro da bi pročitala naučni text na engleskom!!!
Samim tim neće ni puno značiti što postoji.
Mislim da bismo trebali da dobijemo ovaj text samo preveden na naš maternji jezik.


Vrh
 Profil  
 
 Tema posta:
PostPoslato: Čet Feb 22, 2007 12:18 am 
OffLine
Aktivan član
Aktivan član

Pridružio se: Ned Nov 21, 2004 2:56 pm
Postovi: 383
Lokacija: Zemun
:lol: Da li da postavim pitanje na engleskom ili srpskom? Salim se, razumela sam tekst. Zanima me da li duza upotreba progesterona moze da dovede do izostanka porodjajnih kontrakcija? Ja sam pila utrogestan 5 mes. i nisam imala kontrakcije pa su mi dali indukciju posto mi je termin proso 9 dana. Par lekara u Frontu mi je tad reklo da je verovatno Utrogestan krivac, pa me zanima i Vase misljenje.

_________________
moja dva sunasca - LENA 15.08.2006. u 15:10 i VASILIJE 10.04.2008. u 02:15


Vrh
 Profil  
 
 Tema posta:
PostPoslato: Sub Feb 24, 2007 12:42 am 
OffLine
Stalni član
Stalni član

Pridružio se: Sre Jan 12, 2005 12:01 am
Postovi: 1058
Lokacija: Beograd
Draga trudnjačo,
Kada porođaj zaista počne ništa ga nemože zaustaviti, najmanje Progesteron!
Problem je što kolege iz različitih motiva, najčešće straha, neznanja, ličnog komfora (da nebi noću dolazili na kliniku) krenu da se mešaju u prirodni proces na tzv. "nezreo" grlić materice i donji materični segment, a onda nastaje dugo mučenje.
Postoji egzaktno bodovanje zrelosti grlića po Bischopu >9, pomoću koga se tačno procenjuje mogućnost za tzv. indukciju bilo Syntocinonom ili još bolje tj. efikasnije sa prostaglandinima PGE2 ili PGF.

Sem Georgine iz Radovana trećeg neznam ni jednu ženu koja se nije porodila za devet meseci! :)

Pozdrav Dr PeđaDj


Vrh
 Profil  
 
 Tema posta:
PostPoslato: Sub Feb 24, 2007 12:56 pm 
OffLine
Aktivan član
Aktivan član

Pridružio se: Ned Nov 21, 2004 2:56 pm
Postovi: 383
Lokacija: Zemun
Dobro, Georgina se jos nije porodila, ja bar jesam :lol:
Za Olju - poenta teksta je da davanje progesterona smanjuje rizik od prevremenog porodjaja kod zena koje su vec ranije imale prevr.porodjaj, a da bi trebalo da se uradi novo istrazivanje da se vidi da li treba progesteron davati i zenama u prvoj trudnoci kod kojih postoji rizik od prevremenog porodjaja. ("Hydoxyprogesterone is used now for women with a history of preterm birth. We need to perform large randomized trials first before we know if it should be used for women during their first pregnancy with a risk of preterm birth." )
Poslala sam ti opsirnije na pp[/code]

_________________
moja dva sunasca - LENA 15.08.2006. u 15:10 i VASILIJE 10.04.2008. u 02:15


Vrh
 Profil  
 
 Tema posta:
PostPoslato: Sub Mar 17, 2007 12:52 am 
OffLine
Aktivan član
Aktivan član

Pridružio se: Čet Feb 01, 2007 12:48 am
Postovi: 472
Šta se radi u ovom slučaju?
Žena je rodila bebu, nakon 2-3 meseca ponovo ostane trudna i prepišu joj progesteron.
Da li sme da nastavi da doji svoju bebu, i da li je dojenje štetno ako majka koristi progesteron?


Vrh
 Profil  
 
 Tema posta:
PostPoslato: Uto Mar 20, 2007 11:41 pm 
OffLine
Stalni član
Stalni član

Pridružio se: Sre Jan 12, 2005 12:01 am
Postovi: 1058
Lokacija: Beograd
Draga Dr.Olja
još naše bake su prekidale sa dojenjem kada bi spoznale da su trudne. Visoki nivo hormona u trudnoći, (pa i progesterona) stvorenih od strane placente je viši od onog unešenog, može i utiče na bebu koju žena doji.

Pozdrav Dr PeđaDj


Vrh
 Profil  
 
 Tema posta:
PostPoslato: Sre Mar 21, 2007 12:01 pm 
OffLine
Stalni član
Stalni član

Pridružio se: Pon Feb 28, 2005 2:56 pm
Postovi: 1378
Kako da izdrzim a da ne komentarisem ?

To je vrlo MALO istrazivanje ! Ukupan broj pacijenata je 22 ! Cak i da je veci broj pacijenata rijetko koji univerzitetski centar mijenja protokole bazirano na rezultatima jednog malog istrazivanja ( na 22 pacijenta ), koje se zove pilot study i jedino je interesantno za procitati, a ne za primijeniti.

Drugo, nemam vremena da procitam istrazivanje i vidim kako je statisticki obradjeno i da kako su radili randomizaciju, koji su im bili inclusio and exclusion criteria, ko su bili assessor rezultata, i koju su statisticku analizu koristili, ali pogledacu...u svakom slucaju do sada sto sam ja cula od kolega koji se bave MFM IZGLEDA DA JE JEDINO RAZUMNO DAVATI OVE VISOKE DOZE PROGESTERONA KOD PACIJENTKIJA KOJE SU IMALE PRETHODNU ISTORIJU PRIJEVREMENIH PORODJAJA.

JOS UVIJEK TO NE OPRAVDAVA DAVANJA PROGESTERONA SAKOM I KAPOM KAKO SE DAJE KOD NAS KOD SPONTANOG POBACAJA JER I DALJE TO NEMA NAUCNOG OPRAVDANJA.

_________________
Pozdrav,
ObGyn


Vrh
 Profil  
 
 Tema posta:
PostPoslato: Uto Mar 27, 2007 10:53 pm 
OffLine
Stalni član
Stalni član

Pridružio se: Sre Jan 12, 2005 12:01 am
Postovi: 1058
Lokacija: Beograd
Teško je izdržati slažem se! :lol:
Tekst je interesantan jer predstavlja pokušaj objašnjava mehanizma dejstva Progesterona.

Ali evo i jednog malo većeg ispitivanja.

"Vaginal Progesterone Reduces Risk of Preterm Birth"

Laurie Barclay, MD
Medscape Medical News 2003. © 2003 Medscape

Feb. 27, 2003 — Vaginal progesterone reduces the frequency of uterine contractions and the risk of preterm birth, according to the results of a randomized trial reported in the February issue of the American Journal of Obstetrics and Gynecology.

"Preterm delivery is a leading cause of neonatal morbidity and mortality. Thus, the prevention of preterm delivery has become one of the major objectives of perinatal medicine," write Eduardo B. Da Fonseca, MD, and colleagues from the University of Sao Paulo Medical School in Brazil. "An increase in the number of uterine contractions precedes the onset of preterm labor, and the frequency of uterine contractions in pregnancies with preterm delivery is higher than in women with term and postterm delivery."

In this double-blind study, 142 women with high-risk singleton pregnancies received 100 mg progesterone or placebo daily by vaginal suppository. Between 24 and 34 weeks of gestation, all subjects had uterine contraction monitoring with an external tocodynamometer once weekly for 60 minutes.

Preterm births occurred in 30 women overall (21.1%). Compared with the placebo group, the progesterone group fared better in terms of percentage with abnormal uterine activity (23.6% vs. 54.3%); preterm births before 37 weeks (13.8% vs. 28.5%); and deliveries before 34 weeks (2.7% vs. 18.5%; P < .05 for all comparisons).

"Prophylactic vaginal progesterone reduced the frequency of uterine contractions and the rate of preterm delivery in women at high risk for prematurity," the authors write. "The role of progesterone in pregnancy is unclear; however, we know that the effect of progesterone on the myometrium is two-fold: it suppresses the action of estrogen by inhibiting the replacement of cytosolic estrogen receptors and it exerts a direct effect on the biosynthetic processes of the uterus through its own cellular receptor."

The authors note that the prophylactic use of natural progesterone may be associated with decreased uterine contractions, but that this alone cannot explain the lower rate of preterm delivery. They recommend confirming these results in multicenter randomized clinical trials.

In an accompanying editorial, associate editor Jay D. Iams, MD, agrees that the sample size is insufficient to determine whether progesterone supplementation can reduce perinatal morbidity. "Although it is not yet time to treat all women at risk for preterm birth with supplemental progesterone, it is not too soon to hope that these early reports will be followed by larger series showing not only a decline in preterm birth but a reduction in perinatal morbidity and mortality as well," he writes.

Am J Obstet Gynecol. 2003;188:419-424

Normalno da Progesteron nije čaroban lek, a i razlozi prevremenog porođaja su mnogobrojni, te ne može svuda da pomogne, ali u ovom ispitivanju prevremeni porođaj dogodio se ukupno kod 30 trudnica(21.1%). Upoređujući sa placebo grupom (bez P), "Progesteronska grupa" stoji daleko bolje, prisustvo abnormalnih uterinih aktivnosti (23.6% nasuprot 54.3%); prevremen porođaj pre 37 nedelje (13.8% nasuprot 28.5%); porođaj pre 34 nedelje (2.7% nasuprot 18.5%; P < .05 for all comparisons).

Pozdrav Dr PeđaDj


Vrh
 Profil  
 
Prikaži postove u poslednjih:  Poređaj po  
Započni novu temu Odgovori na temu  [ 9 Posta ] 

Izdvajamo za vas:



Sva vremena su u UTC + 2 sata


Ko je OnLine

Korisnici koji su trenutno na forumu: Google Adsense [Bot] i 6 gostiju


Ne možete postavljati nove teme u ovom forumu
Ne možete odgovarati na teme u ovom forumu
Ne možete monjati vaše postove u ovom forumu
Ne možete brisati vaše postove u ovom forumu

Pronađi:
Idi na:  
Powered by phpBB © 2000, 2002, 2005, 2007 phpBB Group
 
Besplatno preuzmite doktor.rs aplikaciju za Vaš Android uređaj!
Ili skenirajte QR kôd sa vašim Android uređajem za najbrže preuzimanje: