Shaikh Zinnat Ara Nasreen
Z H Shikder Women’s Medical College Hospital, Bangladesh

Title: Progesterone-to support pregnancy; Analysis of meta- analysis
Time: 15:20 - 15:50

Biography

Professor Shaikh Zinnat ara Nasreen is working relentlessly for the improvement of women’s health. She has graduated from Dhaka medical college in 1984 with honours marks in Medicine and in anatomy. She obtained Gold Medal for extraordinary academic activities. Later she obtained her FCPS degree from BCPS and Mph from North South University. She also got MRCOG and FRCOG from Royal college of Obs/Gyne, UK. She is at present working as professor and Head of obs/gyne dept of ZHSikder women’s medical college and hospital, Dhaka. She has national and international publication and she had attended several international conferences. At present she is the secretary general of BMS and organizing secretary of OGSB, and Member secretary of BCPS.

Research Interest


Abstract

Pregnancy loss brings tremendous psychological effect. Empirical treatments are aspirin, heparin and progesterone. Progesterone from corpus luteum, placenta is the key hormone for implantation and maintenance of pregnancy. Much work is going on since 1940, removal of corpus luteum is associated with pregnancy loss but replacement with progesterone can help to maintain the pregnancy. Progesterone antagonists readily induces abortion. Deficiency of progesterone may lead to Pre term birth (PTB). The safety of progesterone was reported and showed no anomalies.

 Meta-analysis of 60 RCT (1989) showed that pregnancies reached at least 20 weeks RR =3.09 (95% CI 1.28-7.42) with progesterone and meta-analysis (2002) suggested luteal support with progesterone is superior to HCG. Level evidence 1 support, progesterone prevents PTB. On the contrary study by Mohammed reported, progesterone in any route proved to have limitation and side effects. Meta-analysis of 25 articles stated luteal support of progesterone is unnecessary for it, slow benefits, costs and side effects.  Meta-analysis of 53 publications by Leyan showed progesterone resulted increase in pregnancy rate odds (OR= I.12; p<0.01), but the study of Stephanie Castillo (PROMISE) reflected, benefit of progesterone is not proven for miscarriage. Amanda  (2017) showed that 2/3 of women who used progesterone, successfully delivered despite they had previous two miscarriages. Meta-analysis of 10 RCT by Saccon G showed progesterone in 1st trimester lowered risk for pregnancy loss (RR 0.72; 95% CI, 0.53-0.97).

Suk-Joo Choi stated, progesterone is effective in preventing PTB. Meta-analysis analysed 39 RCT showed lowered risk of PTB with progesteron. In contrast OPTIMUM and PROGRESS trials found no significant benefits but OPTIMUM study showed progesterone reduces PTB where Cervix is shortened. Progesterone is not effective for preventing PTB following PROM.

Meta-analysis of 168 articles (Salim Daya) suggested use of progesterone but efficacy has not been demonstrated. Mesen supported exogenous progesterone for Luteal phase support in ART.  Meta-analysis by Katherene 2017 concluded, progesterone as luteal support is beneficial, live birth rate (RR 1.77, 95% CI 1.30-2.42).

Conclusion

Analysis of Meta-analysis suggested, progesterone supports pregnancy. But the optimum dose, type, route, nature, duration and starting time are not been evaluated.