الفهرس 
AcknowledgmentsOnly 14 pages are availabe for public view
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Abstract
Prematurity is defined as birth before 37 completed weeks of gestation. The condition is the leading cause of neonatal mortality and morbidity. 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. Spontaneous preterm labor can be understood as a syndrome with a number of underlying factors including infection, maternal stress, past history of induced abortions, uterine abnormalities, previous preterm birth, life style, behaviour and socioeconomic state. Uterine distension, placental hypoxia and bleeding also contribute. Many obstetric disorders in the current pregnancy as bleeding, pre-eclampsia, multiple pregnancy and cervical incompetence share in the occurrence of preterm labor. Preterm labor is a clinical diagnosis including regular uterine contractions, diltation and shortening of the cervix. Methods of prediction of preterm labor include history, cervical examination, ultrasound evaluation of the cervix and home uterine monitoring. Also human chorionic gonadotropin and oncofetal fibronectin assay. Cervical length measurement is a useful parameter for assessing risk of preterm delivery. Bacterial investigation is indicated in cases with abnormal vaginal discharge. Antibiotic treatment is advocated in symptomatic bacterial vaginosis, urinary tract infection, infection with group B-streptococci and intrauterine infections. Cervical cerclage may have a place in selected cases of cervical failure without contraction. Tocolytic treatment should be used between 20 and 34 weeks’ gestation, to prolong pregnancy in cases of preterm labor; to allow fetal lung maturation following administration of corticosteroids. The use of tocolytic agents does not reduce neonatal morbidity and mortality. Progesterone is an essential hormone in the process of reproduction, it is involved in the menstrual cycle regulation, implantation and is essential for pregnancy maintenance. Progesterone acts to relax smooth muscle in many organs including the pregnant uterus. Progesterone has immunesuppressive activity against the activation of T-lymphocytes, and blocks the effects of oxytocin on myometrium. In this study 90 pregnant women divided into three groups: one group had taken 100mg capsule progesterone (prontogest treatment) every day at bed time, starting from week 20, till the end of 34weeks gestation, the secondc 250 mg intramuscular 17 hydroxy Progesterone caproate (cidolut depot treatment) every week, also starting from week 20 till the end of 34weeks gestation, and the third group had taken nothing (No.intervention), between 20 weeks until 34 weeks gestation, at Assiut University Woman’s Health Hospital. For every pregnant woman in this study, the following had been done: 1. Complete history taking including obstetric, family and past history. 2. General examination to exclude infection. 3. Obstetrical examination. The inclusion crieteria of the pregnant women included in this study: 1. Past history of one or more spontaneous preterm labour. 2. Singleton pregnwncy. 3. Pregnancy of less than 20 weeks of gestation. Results were statistically analysed, it was found that, there was a reduction in the rate of preterm labour in injection more than oral groups, as was shown from statistical significant difference between Injection and Oral, and between Injection and No-intervention groups, while no statistical significant difference between oral and no-intervention groups. Also, birth weight and women satisfaction score were higher in Injection group, followed by Oral and No-intervention group with statistical significant difference. It was found that the mean age was higher in “Oral” group than “Injection” and “No-intervention” groups, and there was a significant difference between “Oral” and “No-intervention”. While there was no statistical significant difference between groups regarding residence, education and occupation. >To summarize, this study support that 17α-hydroxy progesterone caproate is a more successful drug in the prevention and decreasing the rate of recurrent preterm labour, than the oral progesterone.