Evaluating the Effect of Utrogestan on Idiopathic Intrauterine Growth Retardation

Mohammadi, Belgheis; Matinfar, Marzieh; Drees, Fatemeh; Shabanian, Sheida

Evaluating the Effect of Utrogestan on Idiopathic Intrauterine Growth Retardation

Authors

¹ Department of Gynecology and Obstetrics, Shahrekord University of Medical Sciences, Shahrekord, Iran

² Departments of Gynecology and Obstetrics, Student of Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran

³ Department of Epidemiology and Biostatistic, Shahrekord University of Medical Sciences, Shahrekord, Iran

Abstract

Background: Intrauterine growth factor (IUGR) is one of the most important causes of neonatal mortality. The aim of this study was to evaluate the therapeutic effect of utrogestan on the treatment of IUGR and its complications. Materials and Methods: In this clinical trial, 66 pregnant women with idiopathic IUGR embryos were enrolled. Patients in the intervention group, in addition to receiving routine treatment of control group (high-protein diet, resting), took utrogestan capsules (100 mg) twice daily. The primary and secondary outcomes of the disease were recorded in a checklist. Data were analyzed using SPSS 18 using an independent t-test, Chi-square test, and Fisher's exact test. Results: In the intervention group, mean neonatal weight (P = 0.003), mean neonatal Apgar score (P = 0.001), and mean gestational age at birth (P = 0.001) were significantly higher than those in the control group. There was no neonatal death in the intervention group, whereas in the control group, four cases of neonatal death were observed (P = 0.03). In the majority of subjects in the intervention group, resistance index, and pulsatility index of the umbilical artery decreased (P = 0.002). The difference in abdominal circumference and gestational age in the intervention group decreased (P = 0.01). In the intervention group, the diastolic flow of the umbilical artery increased (P = 0.002). Conclusion: Utrogestan was effective as an inexpensive and effective way to treat IUGR and improve pregnancy outcomes.

Keywords

References

1.	Sharma D, Shastri S, Farahbakhsh N, Sharma P. Intrauterine growth restriction – Part 1. J Matern Fetal Neonatal Med 2016; 29(24):3977-87.
2.	Said, Joanne M. The role of proteoglycans in contributing to placental thrombosis and fetal growth restriction. J Pregnancy 2011;2011:1-5.
3.	Pereira L, Petitt M, Fong A, Tsuge M, Tabata T, Fang-Hoover J, et al. Intrauterine growth restriction caused by underlying congenital cytomegalovirus infection. J Infect Dis 2014;209 (10):1573-84.
4.	Gaudineau A.[Prevalence, risk factors, maternal and fetal morbidity and mortality of intrauterine growth restriction and small-for-gestational age]. J Gynecol Obst Bio R 2013; 42 (8):895-910.
5.	Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr 2016; 10:CMPed-S40070.
6.	Bazer FW, editor. Endocrinology of pregnancy. Springer Science & Business Media; 2012 Dec 6. [Last accessed on 2015 Dec 07]
7.	Borna S, Bandarian M, Abdollahi A, Bandarian F, Malek M. Maternal progesterone level in fetal growth restriction and its relationship with Doppler velocimetry indices. Iran J Radiol 2011;8(1):33-7.
8.	Alberry M, Soothill P. Management of fetal growth restriction. Arch Dis Child Fetal Neonatal Ed 2007; 92(1):F62-7.
9.	Wadhwa L, Batra S, Tempe A. Role of dydrogesterone in the treatment of idiopathic IUGR. Int J Reprod Contracept 2016;2:157-60.
10.	Gunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC, Wenstrom KD. Williams Obestetrics. 22^th ed. Philadelphia: McGrow-Hill; 2005. p. 1049.
11.	Khong SL, Kane SC, Brennecke SP, da Silva Costa F. First-trimester uterine artery Doppler analysis in the prediction of later pregnancy complications. Dis Markers 2015;2015:1-10.
12.	Njoku C, Emechebe C, Odusolu P, Abeshi S, Chukwu C, Ekabua J. Determination of accuracy of fetal weight using ultrasound and clinical fetal weight estimations in calabar South, South Nigeria. Int Sch Res Notices 2014;2014:1-6.
13.	Kalem MN, Kalem Z, Bakırarar B, Ergün A, Gürgan T. The effect of progesterone use in the first trimester on fetal nuchal translucency. J Turk Ger Gynecol Assoc 2018;19:29-33.
14.	Marinov B, Petkova S, Dukovski A, Georgiev G, Garnizov T, Manchev V, et al. Utrogestan and high risk pregnancy. Akush Ginekol (Sofiia) 2004;43(5):22-4.
15.	Yassaee F, Shekarriz-Foumani R, Afsari S, Fallahian M. The effect of progesterone suppositories on threatened abortion: A randomized clinical trial. J Reprod Infertil 2014;15(5):147-51.
16.	Diemert A, Goletzke J, Barkmann C, Jung R, Hecher K, Arck P. Maternal progesterone levels are modulated by maternal BMI and predict birth weight sex-specifically in human pregnancies. J Reprod Immunol 2017;121:49-55.
17.	Vafaei H, Zamanpour T, Raeisi Shahraki H. Preterm birth prevention: Effects of vaginal progesterone administration on blood flow impedance in uterine-fetal circulation by Doppler sonography. Glob J Health Sci 2015;8:172-8.
18.	Mark PJ, Smith JT, Waddell BJ. Placental and fetal growth retardation following partial progesterone withdrawal in rat pregnancy. Placenta 2006;27:208-14.
19.	Nama N, Ehsan N. Synopsis effect of oral dydrogesterone on mean neonatal birth weight in the treatment of idiopathic intra uterine growth restriction-A synopsis. J Pioneer Med Sci 2016;6(2):23.
20.	Farahbod F, Soureshjani SH. A systematic review of medicinal plants and plant derivatives affecting increase in endometrial thickness. Int J Pharm Sci Rev Res (IJPSR). 2018;9(1):53-7.
21.	Noé G, Sitruk-Ware R, Zegers-Hochschild F, Variano B, Montero JC, Arriagada P, et al. Endometrial effect of progesterone delivered by vaginal rings in estrogen-treated postmenopausal women. Climacteric 2010;13:433-41.
22.	Maliqueo M, Echiburú B, Crisosto N. Sex steroids modulate uterine-placental vasculature: Implications for obstetrics and neonatal outcomes. Front Physiol 2016;7:152.
23.	Flood PF, Tyler NJ, Read EK, Rodway MJ, Chedrese PJ. Ovarian and placental production of progesterone and oestradiol during pregnancy in reindeer. Anim Reprod Sci 2005;85:147-62.
24.	Omar HA, Ramirez R, Gibson M. Properties of a progesterone-induced relaxation in human placental arteries and veins. J Clin Endocrinol Metab 1995;80:370-3.
25.	Yavangi M, Rabiee S, Nazari S, Farimani-Sanoee M, Amiri I, Bahmanzadeh M, et al. Comparison of the effect of oestrogen plus Foeniculum vulgare seed and oestrogen alone on increase in endometrial thickness in infertile women. J Clin Diagn Res 2018;12 (1):QC1-QC4.
26.	Zhu X, Zhang X, Fu Y. Utrogestan as an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization. Medicine (Baltimore) 2015;94:e909.

Advanced Biomedical Research