Uso de progestágenos em mulheres com ameaça de aborto ou história de aborto recorrente-Anna Cristina

Summary

This video explores the use of progestogens to prevent spontaneous abortion and recurrent miscarriage. It highlights the role of progesterone in maintaining pregnancy and evaluates whether progestogen supplementation increases live birth rates in women with early pregnancy bleeding or a history of previous miscarriages. A 2020 meta-analysis involving over 5,600 women concluded that micronized vaginal progesterone significantly improved live birth rates in women with such histories. However, the study indicates uncertainties about the efficacy and safety of other progestogen treatments and calls for further research. The video emphasizes the importance of consulting healthcare professionals.

Takeaways

• 😀 Miscarriage (spontaneous abortion) occurs in 1 in 5 pregnancies, and 1 in 4 women experience a miscarriage in their lifetime.
• 😀 The term 'threatened abortion' refers to vaginal bleeding before the 20th week of pregnancy, while 'recurrent abortion' refers to three or more consecutive miscarriages.
• 😀 Progestagens, such as progesterone, play a crucial role in maintaining pregnancy by stimulating changes in the uterus to support the growing fetus and prevent premature contractions.
• 😀 A 2020 meta-analysis investigated the effect of progestagen supplementation on reducing the risk of miscarriage and increasing live births in women with threatened or recurrent abortion.
• 😀 The PICO method (Population, Intervention, Comparison, Outcome) was used to structure the review, focusing on women with gestation confirmed, bleeding, and a history of previous miscarriages.
• 😀 The review analyzed 7 studies with a total of 5,682 women from countries like Australia, Germany, and the UK, focusing on the effectiveness of different progestagen types compared to placebo.
• 😀 The study found that micronized vaginal progesterone was the only progestagen that showed a significant increase in live birth rates, especially in women with early pregnancy bleeding and a history of previous miscarriage.
• 😀 The results of the study were statistically significant, with a relative risk increase of 8% for successful pregnancy outcomes with vaginal micronized progesterone.
• 😀 No significant benefit was observed with other types of progestagens, and the study highlighted that the progesterone treatment's effectiveness was limited to specific groups (i.e., women with bleeding and prior miscarriage).
• 😀 The study concluded that micronized vaginal progesterone might help increase live birth rates for women with early pregnancy bleeding and a history of miscarriage, but further studies are needed to confirm its long-term safety and efficacy.
• 😀 The study emphasized the importance of consulting a healthcare provider for personalized advice and cautioned against self-medication, while also calling for more research to refine the understanding of progestagens for miscarriage prevention.

Q & A

What is a spontaneous abortion, and how common is it?

A spontaneous abortion, or miscarriage, is the loss of a pregnancy before the 20th week. It occurs in approximately 1 in 5 pregnancies, meaning about 20% of all pregnancies end in miscarriage.

What is the definition of a threatened abortion?

A threatened abortion is defined as vaginal bleeding before the 20th week of pregnancy, which indicates a potential risk of miscarriage but does not guarantee it will happen.

What is recurrent abortion, and how is it defined?

Recurrent abortion refers to the loss of three or more consecutive pregnancies. It indicates a higher risk of future miscarriages and is a condition that requires medical evaluation.

Why is the use of progestogens considered in the treatment of miscarriage?

Progestogens, particularly progesterone, are considered because they play a crucial role in maintaining pregnancy. They help the uterus to grow and prevent premature contractions, which could lead to miscarriage.

What is the purpose of a systematic review and meta-analysis in scientific research?

A systematic review and meta-analysis aim to synthesize the results of multiple studies on a particular topic to provide more reliable evidence. Researchers aggregate data from several trials to find patterns, draw conclusions, and assess treatment efficacy.

What did the 2020 study on progestogens and miscarriage prevention conclude?

The 2020 study concluded that micronized vaginal progesterone significantly increased the rate of live births in women with early pregnancy bleeding and a history of previous miscarriages. However, the treatment was not effective for all women, especially those without a history of miscarriage.

What is the significance of the term 'risk relative' in the study findings?

'Risk relative' refers to the relative increase or decrease in the likelihood of a desired outcome, in this case, a successful pregnancy. A risk relative of 1.8 indicates that the treatment increased the likelihood of a successful pregnancy by 8% compared to the placebo group.

Did the study show any differences in the incidence of congenital anomalies or adverse events between the treatment groups?

The study found no significant difference in the incidence of congenital anomalies or adverse events between the group using micronized vaginal progesterone and the placebo group, based on moderate to low-quality evidence.

What is the importance of using a placebo in clinical trials like this one?

Using a placebo in clinical trials helps researchers compare the effects of a treatment to an inactive substance, ensuring that any positive outcomes observed are genuinely due to the treatment and not the result of psychological factors or chance.

What are the recommendations for women considering the use of progestogens for preventing miscarriage?

The script advises against self-medication and recommends that women consult with healthcare professionals to discuss the potential benefits and risks of progestogen treatment, as well as to explore other medical options based on their individual health and pregnancy history.