الفهرس 
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Abstract
Summary
reterm birth is the major cause of neonatal mortality and
morbidity. A history of a prior spontaneous PTB
remains the greatest risk factor for spontaneous PTB, These
high- risk women have been the focus of recent trials for the
prevention of recurrent prematurity.
In 2009, 13 million babies were born preterm, 11
million in Africa and Asia and 500, 000 in the USA, The
highest rates of preterm birth are in Africa (11.9%) and North
America (10.6%).
Prematurity represents a major cause of perinatal death
and long term handicap. Although the incidence of preterm
Labor has not changed over many years, neonatology has
advanced, and the survival of babies has improved. Yet,
handicaps continue to occur in babies born at very early
gestational ages. The majority of problems facing preterm
neonates are mainly due to organ immaturity, particularly the
lungs, and it seems clear that the severity is inversely
proportional to gestational ages.
Prevention is directed towards identification of women at
risk recent studies have identified clinical, sonographic, and
biochemical markers that help to identify the women at highest
risk. Determining cervical length and measuring cervicovaginal
P
Summary
1 01
fibronectin have been proposed as useful tools for evaluating
women at risk of preterm birth and may identify those who
might benefit from antenatal corticosteroids, but effective
interventions to prevent preterm birth remain elusive.
The treatment of established preterm Labor should be
directed towards identifying those women in whom a delay in
delivery is likely to be beneficial and those in whom it may be
lethal in terms of neonatal or infant outcome. Although there is
little hard evidence that tocolysis improves the outcome for the
baby, most obstetricians treat threatened uncomplicated preterm
Labor in order to administer steroids or transfer the mother to an
appropriate hospital.
Several trials have shown a reduction in spontaneous
PTB using various formulations of progesterone, offering
progesterone supplementation to women with a prior
spontaneous PTB is now recommended by American College
of Obstetricians and Gynecologists.
Natural (micronized) progesterone is identical to the
progesterone produced by the placenta and corpus luteum and
so is readily metabolized and associated with minimal side
effects.
There has been a recent reappearance of interest in the use
of progesterone supplementation to prevent preterm delivery in
Summary
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high-risk patients as evidenced by two recent trials; the results of
da Fonseca study and the Meis trial support the hypothesis that
progesterone supplementation reduces preterm birth in a select
very high-risk group of women.
In 2003, the American College of Obstetricians and
Gynecologists (ACOG) issued a Committee Opinion entitled
”Use of progesterone to reduce preterm birth ”.
This is a randomized control trial was carried out to
evaluate the effectiveness of use Intramuscular 17Alphahydroxyprogestrone,
Progesterone suppositories and
Dydrogesterone tablets in preventing preterm labor in high
risk women.
A total of 120 pregnant women at risk of preterm labor
were recruited in the trial. They were divided into 3 groups:
Vaginal Progesterone group (n=40), including women
who received vaginal progesterone.
IM HPC group (n=40), including women who received
intramuscular 17-hydroxyprogesterone caproate.
Oral Dydrogesterone group (n=40), including women
who received oral dydrogesterone.
Primary outcome was Gestational age at delivery there
were a statistically significant difference between the 3
groups regarding gestational age at delivery.it was
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significantly higher in vaginal & IM group when compared
to oral group, However there was no statistical difference
between the vaginal & IM groups in mean gestational age.
There were no significant differences between women
of the three groups regarding Preterm Delivery (< 37 weeks’
gestation) & aslo no significant differences between women
of the three groups regarding Early Preterm Delivery(< 34
weeks’ gestation).