الفهرس 
Preterm Birth (PTB)Only 14 pages are availabe for public view
 |  | from | 153 |  |  |
| | | from | 153 | | |
Abstract
Preterm birth (PTB), defined as delivery before 37 weeks of gestation, is the most important cause of neonatal morbidity and mortality. Two-thirds of PTBs are spontaneous, and one-third comprises induced PTB for medical reasons, mainly preeclampsia and/or fetal growth restriction.
Children who are born preterm often have short-term morbidities such as respiratory difficulties (infant respiratory distress syndrome), periventricular leukomalacia, intracranial hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, retinopathy of prematurity, and infection. In the long term, many of these children suffer from neurological and developmental disabilities.
The risk of complications is directly proportional to the severity of prematurity; adverse neonatal outcome declines from 77% at 24–27 weeks to less than 2% beyond 34 weeks. Therefore, preventing PTB is one of the main goals in obstetric care:
In women with single gestation pregnancy and a history of spontaneous preterm delivery. Progesterone supplementation is beneficial in these women starting at 16 to 24 weeks’ gestation and continuing through 34 weeks’ gestation. Vaginal progesterone can be used in women with no history of spontaneous preterm delivery if they have a cervical length of 20 mm or less before 24 weeks’ gestation. Treatment with vaginal micronized progesterone, 200 mcg daily, was associated with a 44% reduction in spontaneous preterm delivery in asymptomatic women with a cervical length of 15 mm or less at 20 to 25 weeks’ gestation.
Meta-analyses and systematic reviews of trials of low-dose aspirin (60– 150 mg a day) in pregnant women for the prevention of pre-eclampsia suggest that women receiving aspirin have a reduced occurrence of preterm
Summary
81
birth and a reduced frequency of pre-eclampsia particularly if initiated before 16 weeks of gestation. Low-dose aspirin (LDA) is attractive as a potential prophylactic agent against preterm birth, because it is inexpensive, widely available, and has a reasonable safety profile during pregnancy.
So, the aim of the study was to assess the efficacy and safety of low dose of Aspirin and Vaginal Progesterone alone and in combination in the prevention of preterm birth.
To elucidate our aim, this study was randomized clinical trial to study efficacy and Safety of Low-Dose Aspirin and Vaginal Progesterone in the prevention of Spontaneous Preterm Birth. The study population consisted of 141 pregnant women’s was undertaken in Obstetrics and Gynecology Department in Samanoud general hospital at El gharbiya Governorate in period time from October 2020 to June 2022.
Pregnant women in this study were sub divided into three groups: Aspirin group: included 47 pregnant women who started taking low dose of aspirin75 mg one tablet per day alone, Progesterone group: Included 47 pregnant women who started taking vaginal progesterone 200 mg/night alone, Combination group: Included 47 pregnant women who started taking low dose of aspirin 75 mg/day and vaginal progesterone 200 mg /night.
All patients were subjected to the following: Written or informed consent. Full history taking included personal history, menstrual history, obstetric history and past history. General clinical examination included general look as pallor, jaundice and tremors, vital signs blood pressure pulse, temperature and respiratory rate, head and neck examination, cardiac examination, chest examination. Laboratory & Radiological Investigations included complete blood count (CBC), urine analysis, ultrasound scan, the cervical length was measured.
Summary
82
Results of the current study could be summarized as follows:
There were no significant differences among the studied groups regarding age, body mass index, residence, gravidity, parity and occupation status (P>0.05).
There was a significant difference between Aspirin, Progesterone and Combination groups regarding early Preterm birth <34 weeks (P= 0.024). while there were no significant differences among the studied groups regarding Preterm birth <37 weeks (P> 0.05).
There were no significant differences among the studied groups regarding Heart rate, systolic blood pressure and diastolic blood pressure (P>0.05).
There were no significant differences among the studied groups regarding gestational age at recruitment, gestational age at birth, Birth weight, Apgar score, Admission to NICU and Neonatal mortality (P>0.05).
There were no significant differences among the studied groups regarding pre-eclampsia, infection, placental and Post partum hge (P>0.05).
The results of multiple logistic regression analysis indicated that cervical length, preeclampsia and Premature rupture of membranes were the most significant factors affected on spontaneous preterm birth (P<0.05). While, age, body mass index, gravidity, parity, heart rate, systolic blood pressure, diastolic blood pressure, hemoglobin, previous preterm birth didn’t show significant association with spontaneous preterm birth (P>0.05).