Latar Belakang: Ketuban pecah dini (PPROM) merupakan suatu kondisi yang menyebabkan peningkatan risiko kesakitan dan kematian ibu dan bayi pada ibu hamil. Kesimpulan: Berdasarkan review jurnal yang dikumpulkan, salah satu terapi yang dapat digunakan untuk memperpanjang fase laten dan menurunkan risiko ketuban pecah dini adalah dengan pemberian progesteron. Ketuban Pecah Dini (PROM) atau Premature Rupture of the Membran (PROM) adalah kondisi pecahnya selaput ketuban sebelum melahirkan pada kehamilan cukup bulan.
Laporan lain menemukan bahwa ketuban pecah dini terjadi pada sekitar 6–8% wanita sebelum usia kehamilan 37 minggu dan mendahului 20–50% dari seluruh kelahiran prematur ( Getahun et al., 2012 ). Ketuban pecah dini berhubungan dengan komplikasi kelahiran prematur dan terjadinya infeksi korioamnionitis yang dapat meningkatkan morbiditas dan mortalitas perinatal. Salah satu penyebab utama kelahiran prematur adalah ketuban pecah dini (PPROM) yang terjadi pada 3% dari seluruh kehamilan.
Intervensi yang diberikan pada ketuban pecah dini antara lain penggunaan antibiotik, kortikosteroid, tokolitik, cerclage serviks dan terutama progesteron.
SKENARIO KLINIS
Proses terbukanya leher rahim akibat nya ini terbagi menjadi 2 fase yaitu fase laten dan fase aktif.
RUMUSAN MASALAH
STRATEGI PENCARIAN
Kala pertama (pembukaan jalan lahir) diawali dengan kontraksi uterus yang teratur dan diakhiri dengan dilatasi serviks secara sempurna. 5 hari pada kelompok kontrol dalam usia kehamilan 28 hari-30 minggu, yang secara signifikan lebih tinggi pada kelompok intervensi (P = 0,0,001). Kelemahan penelitian ini adalah ikan tidak mendapatkan hasil efektivitas perbedaan dosis progesteron yang diberikan.
PEMBAHASAN
Maher (2017) melakukan uji klinis acak untuk membandingkan efektivitas supositoria intramuskular dengan vagina dan menemukan bahwa metode vagina secara signifikan lebih baik pada dosis yang lebih rendah. Menurut Elena (2020) yang meneliti efek terapi progesteron terhadap kondisi psikologis dan kelahiran prematur menyatakan bahwa pemberian terapi progesteron sangat mempengaruhi penurunan angka PPROM. Dimana status psikologis individu ibu hamil merupakan faktor risiko penting terjadinya persalinan prematur.
Dalam penelitian ini, penurunan optimisme yang signifikan dan peningkatan gejala depresi dan kecemasan diamati delapan minggu sebelum kelahiran prematur (RR risiko relatif adalah 1,5), sedangkan pada wanita dengan persalinan cukup bulan, tidak ada kejadian seperti itu yang terdeteksi.
KESIMPULAN
Accuracy of the placental alpha-microglobulin-1 test in the diagnosis of premature rupture of membranes. Neonatal and maternal outcomes after midtrimester preterm premature rupture of membranes: a retrospective cohort study. In the intervention group, progesterone suppositories (400 mg per night) were administered until delivery or at the end of the 34th week of pregnancy and compared with the placebo effect in the control group.
5 days in the control group on the 28th-30th. week of pregnancy, which was significantly higher in the intervention group (P=0.001). Morbidity among women in labor is also higher, the most terrifying complications being chorioamnionitis and sepsis (10). Progesterone is a sex hormone that has many well-known roles in normal pregnancy, one being an anti-inflammatory effect that counteracts the inflammatory cytokine that is routinely produced during labor, which precipitates preterm labor.
The current study aims to investigate the effect of progesterone on patients with PPROM and the possible change in the rate of preterm delivery and other pregnancy outcomes and complications related to its use. During the current double-blind randomized controlled trial, which was conducted between February 2014 and April 2016 in educational medical centers of Tabriz University of Medical Sciences (Tabriz, Iran), 120 patients with PPROM were included in the study. Study design and population Inclusion criteria consisted of singleton pregnancy, PPROM (based on agreed definition of membranes uptake prior to 37 weeks of gestation) (25,26) between 26-32 weeks of gestation and mother's wish to participate in the study.
Exclusion criteria were proven fetal abnormalities in previous tests, including genetic testing and structural abnormalities discovered with ultrasound or trisomy screening tests (double marker or Quad Screen Test) between 18-20 and 28-32 weeks gestation, multiple pregnancy, complicated preeclampsia pregnancies, chronic hypertension, overt diabetes, gestational diabetes, abruption, umbilical cord prolapse, and chorioamnionitis, and gestational age greater than 32 weeks at first presentation. In the control group, placebo suppositories (Castor Oil) were used, exactly the same shape and color as the progesterone suppositories. Finally, the outcome of pregnancy was examined using the following criteria: duration of the latent phase (the first step of labor before the cervix dilates), from admission to delivery, route of delivery, wound infection, APGAR score (appearance, pulse, grimace, Activity and respiration), fetal weight at delivery, admission to the NICU (neonatal intensive care unit), neonatal sepsis, the occurrence of chorioamnionitis and puerperal metritis.
There were no significant differences between the two groups in any of the criteria, except for the time from PPROM to initial contractions, when rapture occurred in the 28th-30th week. week of pregnancy in which the time period was 8.5 days in the intervention group and 5 days in the control group (P<0.001) and the average birth weight which was gr in the intervention group and gr in the control group (P=0.03 ). Socio-economic status of the patients included in the study and comparison between the intervention and control groups.
This study evaluated the effect of progesterone on delaying labor after PPROM. This intervention significantly extended this period from an average of 5 days to 8 in the intervention group, which was between 28 and 30 weeks' gestation. Norman et al., conducted a multicenter randomized clinical trial to investigate the effect of progesterone on the prophylaxis of preterm birth in PPROM and found that there was no significant increase in the time period between PPROM and delivery in the intervention group.
They also concluded that progesterone did not increase morbidity or mortality in the mother or child (29). Meis et al. selected 459 patients with a history of preterm birth and injected intramuscular progesterone 250 mg/week in one group and placebo in the other group. The results followed the current study, although neonatal complications such as sepsis and respiratory distress syndrome were not significantly reduced in the present.
Mirzaei et al., also conducted a study to evaluate the effect of progesterone on prolonging pregnancy in patients with PPROM. 171 patients with PPROM were selected, in group 1 (57 patients), they used 17OHP 250 mg/week, in group 2 (57 patients), they used progesterone suppository 400 mg/day and in group 3 (102 patients). He did not use any medication. The mean latency period from rupture of membranes to delivery was 15/5 days in the first group, 15/2 days in progesterone recipients, and 11/5 days in untreated patients. Also, side effects were almost twice as high in the intramuscular group compared to the vaginal group (14.1% vs.
Briery et al. conducted another randomized controlled clinical trial in which patients in the intervention group received 250 mg progesterone and in the control group a placebo. The difference may be due to the different route of administration and the higher dose in the previous study. Crane et al. found that only half of the patients who were potential candidates for progesterone therapy ever received the treatment, and the main reason for this low status was that doctors did not offer this option in the first place.
Also in the current study, the positive effect of progesterone was only observed between the 28th and the 31st week of pregnancy, and no beneficial effect was demonstrated in any other period. National, regional and global estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications.
Vaginal progesterone to prevent preterm delivery among HIV-infected pregnant women in Zambia: A feasibility study
Pregnant women with HIV who were starting or continuing antiretroviral therapy were eligible to participate. We conducted a randomized, double-masked, placebo-controlled pilot trial of VP to prevent PTB among HIV-infected pregnant women in Zambia. This was a randomized, masked, placebo-controlled trial of VP among HIV-infected pregnant women in Lusaka, Zambia.
We excluded women with any of the following: (1) multiple pregnancy; (2) non-research indicators for. Study nurses counseled participants on the correct use of the study product at the randomization visit and at each subsequent study visit. The primary outcome of this study was the proportion of women with adequate adherence, which we defined as using at least 80% of the prescribed study product.[6, 17] Secondary outcomes.
Between July 2017 and June 2018, 140 HIV-infected pregnant women were recruited and randomized at the Kamwala District Health Center in Lusaka (Fig 1). We present the results of a pilot study evaluating the feasibility of a trial of antenatal vaginal progesterone for the prevention of preterm birth among HIV-infected pregnant women without other major risk factors. Some vaginal microbicide studies in HIV-uninfected, non-pregnant women in sub-Saharan Africa have found significant differences between self-reported adherence and objective measures such as DSA and plasma drug con-.
This pilot is the first published randomized trial of vaginal progesterone for the prevention of HIV-related preterm birth. Prophylactic administration of progesterone via vaginal suppositories to reduce the incidence of spontaneous preterm labor in women at risk: a randomized, placebo-controlled, double-blind study. Vaginal progesterone reduces the rate of preterm birth in women with an ultrasound short cervix: a multicenter, randomized, double-blind, placebo-controlled trial.
Vaginal progesterone for preventing preterm delivery and adverse perinatal outcomes in singleton pregnancies with a short cervix: a meta-analysis of individual patient data. Prenatal administration of progesterone for the prevention of preterm labor in women considered to be at risk for preterm labor. Vaginal progesterone to reduce preterm labor among HIV-infected pregnant women in Zambia: a feasibility study protocol.
Perceived acceptability of progesterone for prevention of preterm birth and low birth weight among HIV-infected and HIV-uninfected pregnant Zambian women.
