تأثیر دوزاژ مختلف شیاف پروژسترون بر مقاومت عروق رحمی- جنینی در زنان در معرض خطر زایمان زودرس و مقایسه آن با گروه شاهد

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی سمنان، سمنان، ایران.

2 دستیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی سمنان، سمنان، ایران.

3 دانشیار گروه رادیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی سمنان، سمنان، ایران.

4 دانشیار گروه آمار، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشکده پزشکی اجتماعی، علوم پزشکی سمنان، دانشگاه علوم پزشکی سمنان، سمنان، ایران.

چکیده

مقدمه: علی رغم استفاده گسترده از پروژسترون در بارداری، اما اطلاعات محدودی از تأثیر آن بر گردش خون رحمی-جفتی و به‌خصوص بر سیستم گردش خون جنین در نیمه دوم بارداری موجود است. مطالعه حاضر با هدف بررسی تأثیر دوزاژ مختلف شیاف پروژسترون بر شاخص‌های سونوگرافی داپلر شریان‏ های رحمی، نافی و مغزی میانی جنین، و بروز زایمان پره ‏ترم در زنان در معرض خطر زایمان زودرس انجام گرفت.
روشکار: این مطالعه کارآزمایی بالینی تصادفی دوسوکور در سال‏ های 99-1397 بر روی 90 زن باردار با سن حاملگی 33‏-24 هفته با تشخیص پره ‏ترم لیبر انجام شد. افراد به‌طور تصادفی در سه گروه قرار گرفتند. هر سه گروه در بدو بستری تحت سونوگرافی داپلر شریان‏ های رحمی، نافی و مغزی میانی جنین قرار گرفتند، سپس در گروه اول پروژسترون 400 میلی‌گرم و در گروه دوم پروژسترون 200 میلی‌گرم به‌صورت واژینال تجویز شد و گروه سوم هم به‌عنوان گروه کنترل مورد مطالعه قرار گرفت. هر سه گروه 48 ساعت بعد مجدداً تحت سونوگرافی داپلر قرار گرفتند. مقاومت عروق بر اساس پارامترهای داپلر RI (شاخص مقاومت) و PI (شاخص ضربان‏ پذیری) سنجیده شد. تجزیه و تحلیل داده‏ ها با استفاده از نرم ‏افزار آماری SPSS (نسخه 16) و آزمون‏ های آنالیز واریانس یک‌طرفه، کروسکال والیس، کای‏ اسکوئر، دقیق فیشر، تی‌زوجی، ویلکاکسون، من‌ویتنی‌یو و رگرسیون لجستیک انجام شد. میزان p کمتر از 05/0 معنادار در نظر گرفته شد.
یافته ­ها: سه گروه‏ از لحاظ سن مادر، پاریته، سن حاملگی، طول سرویکس، سابقه زایمان پره‏ترم و RI و PI شریان‏ های رحمی، نافی و مغزی میانی جنین در بدو بستری تفاوت معناداری نداشتند (05/0p>). در هر دو گروه‏ پروژسترون، RI و PI در هر سه شریان رحمی، نافی و مغزی میانی جنین در 48 ساعت بعد از مداخله نسبت به بدو بستری به‌طور قابل توجهی کاهش پیدا کرد (05/0p<). کاهش شاخص‏ های PI و RI همه شریان ‏ها به‌جز PI شریان رحمی (105/0=p)، در 48 ساعت بعد از مداخله در گروه ‏های پروژسترون در مقایسه با گروه کنترل معنادار بود (05/0p<).
نتیجه ­گیری: تجویز تک‌دوز 200 یا 400 میلی‏ گرم پروژسترون واژینال در زنان با سن حاملگی 33‏-24 هفته با تشخیص پره‏ ترم لیبر، موجب کاهش معنادار مقاومت عروق رحمی، نافی و جنینی بعد از 48 ساعت می ‏شود.

کلیدواژه‌ها


عنوان مقاله [English]

The effect of different dosages of progesterone suppositories on uterine-fetal vascular resistance in women at risk of premature delivery and its comparison with the control group

نویسندگان [English]

  • Mozhgan Rahmanian 1
  • Parisa Amini 2
  • Sanaz Ansari 3
  • Majid Mirmohammadkhani 4
1 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
2 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
3 Associate Professor, Department of Radiology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
4 Associate Professor, Department of Statistics, Social Factors Affecting Health Research Center, School of Social Medicine, Semnan Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran.
چکیده [English]

Introduction: Despite the widespread use of progesterone in pregnancy, there is limited information on its effect on uterine-placental blood circulation and especially on the fetal blood circulation system in the second half of pregnancy. The present study was conducted with aim to investigate the effect of different dosages of progesterone suppositories on Doppler ultrasound indices of uterine, umbilical, and middle cerebral arteries of the fetus and the incidence of preterm delivery in women at risk of premature delivery.
Methods: This double-blind randomized clinical trial study was performed in 2018-2020 on 90 pregnant women with gestational age of 24-33 weeks and diagnosis of preterm labor. The subjects were randomly divided into three groups. All three groups underwent Doppler ultrasound of uterine, umbilical, and middle cerebral arteries of the fetus at admission. Then, in the first group progesterone 400 mg and in the second group progesterone 200 mg were prescribed vaginally and the third group was studied as a control group. All the three groups underwent Doppler ultrasound again 48 hours later. Vascular resistance was measured based on RI (resistance index) and PI (pulsatility index) Doppler parameters. Data analysis was done using SPSS statistical software (version 16) and one-way analysis of variance, Kruskal-Wallis, Chi-square, Fisher's exact, paired t-test, Wilcoxon, Man-Whitney, and logistic regression tests. P<0.05 was considered statistically significant.
Results: There were no significant differences among the three groups in terms of maternal age, parity, gestational age, cervical length, history of preterm delivery, RI and PI of the uterine, umbilical, and middle cerebral arteries of the fetus at admission (P>0.05). In both progesterone groups, RI and PI significantly decreased in all three fetal uterine, umbilical, and middle cerebral arteries (P<0.05) in 48 hours after the intervention compared to the beginning of hospitalization. The reduction of PI and RI indexes of all arteries except PI of uterine artery (P=0.105) was significant in 48 hours after intervention in progesterone groups compared to the control group (P<0.05).
Conclusion: The administration of a single dose of 200 or 400 mg of vaginal progesterone in women with gestational age of 24-33 weeks with diagnosis of preterm labor causes a significant decrease in the resistance of the uterine, umbilical, and fetal vessels after 48 hours.

کلیدواژه‌ها [English]

  • Premature birth
  • Progesterone
  • Vascular resistance
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