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Gynecology Case No 17.Threatened Abortion.

Progesteron Role in Pregnency.

Threatened_abortion_এ_প্রোজেস্টেরন_কেনো_দেওয়া হয়?

জেনে নিন–

যেদিন ব্লিডিং হয়, ওইদিন কে বলে first day of period…

Bleeding কয়দিন হয়?

৩-৪ দিন–কারো ক্ষেত্রে ৫-৭ দিন—

Uterus কে healthy রাখে একটা Hormone, যার নাম প্রোজেস্টেরন,

এই প্রোজেস্টেরন কোথায় থেকে আসে?

Ovulation হবার পরে Follicle এর যে বাকি অংশ থাকে৷ তাকে বলে corpus luteum..

Ovulation period এর কততম দিনে হয়?

১৪ তম দিনে হয়,

১৪ তম দিন থেকে ২৪-২৫ তম দিন পর্যন্ত corpus luteum থেকে প্রোজেস্টেরন হরমোন রিলিজ হয়– যা Uterus কে healthy রাখে– conceive না করলে ২৪-২৫ তম দিনে এই Corpus luteum dissolve হয়ে যায়, Progesterone তৈরি বন্ধ হয়, এবং পিরিওড হয়

এখন ovulation এর পরে যদি conceive করে, তাহলে placenta থেকেও progesterone hormones তৈরি হয়,

তখন Corpus luteum and placenta দুইটা থেকে তৈরি হওয়া

এই প্রোজেস্টেরন হরমোনের কাজ কি?

Placenta কে Uterus এর গায়ে শক্ত করে লাগিয়ে রাখা —

এখন কারো placenta যদি proper amount এ progesterone তৈরি না করে, তাহলে কি হবে?

তাহলে placenta Uterus এর সাথে শক্তভাবে লেগে থাকবেনা-

তখন কি কি হতে পারে?

1.. Early pregnancy তে bleeding হতে পারে,

2.. Threatened abortion কিংবা

Miscarriage হয়ে যেতে পারে,

3.. এমন কি preterm Labour ও হতে পারে,

এখন ধরুন, কারো Previous miscarriage এর হিস্ট্রি আছে, তাহলে তার অনেক কারণের মধ্যে খুব কমন একটা কারণ হলো imbalance of progesterone,

মানে proper amount e progesterone তৈরি হচ্ছেনা, তাহলে করনীয় কি?

বাহির থেকে ডেইলি ডোজে অথবা Weekly dose এ প্রোজেস্টেরন supplementary দেওয়া হয়–

Duphaston, HPC, HPC DS এইগুলি সব প্রোজেস্টেরন সাপ্লিমেন্টারী

Tablet:1-Duphaston 10 mg(AS A Dydrogesterone As a Duphaston As A Female Sex hormones.)

Indications of Tablet:-Duphaston 10 mg(AS A Dydrogesterone As a Duphaston As A Female Sex hormones.)

 

Progesterone deficiencies:

  • Treatment of threatened miscarriage
  • Treatment of habitual miscarriage
  • Treatment of dysmenorrhoea
  • Treatment of endometriosis
  • Treatment of secondary amenorrhoea
  • Treatment of irregular cycles
  • Treatment of dysfunctional uterine bleeding
  • Treatment of infertility due to luteal insufficiency
  • Luteal support as part of an Assisted Reproductive Technology (ART)

Hormone Replacement Therapy: To counteract the effects of unopposed oestrogen on the endometrium in hormone replacement therapy for women with disorders due to natural or surgical induced menopause with an intact uterus.

Pharmacology of Tablet:-Duphaston 10 mg(AS A Dydrogesterone As a Duphaston As A Female Sex hormones.)

 

Dydrogesterone is an orally-active progestogen which produces a complete secretory endometrium in an oestrogen-primed uterus thereby providing protection against the increased risk for endometrium hyperplasia and carcinogenesis induced by oestrogens. It is indicated in all cases of endogenous progesterone deficiency. Dydrogesterone has no oestrogenic, no androgenic, no thermogenic, no anabolic and no corticoid activity.

Dosage & Administration of Tablet:-Duphaston 10 mg(AS A Dydrogesterone As a Duphaston As A Female Sex hormones.)

 

Always take Presentation 10 mg tablet exactly as your doctor has prescribed.

Presentationerone deficiencies:

  • Threatened miscarriage: 40 mg (four tablets) at once, then 10 mg (one tablet) every eight hours until symptoms remit.
  • Habitual miscarriage: 10 mg (one tablet) twice daily until the twentieth week of pregnancy.
  • Dysmenorrhoea: 10 mg (one tablet) twice daily from day 5 to day 25 of the menstrual cycle.
  • Endometriosis: 10 mg (one tablet) two or three times daily from day 5 to day 25 of the cycle or continuously.
  • Dysfunctional bleeding (to arrest bleeding): 10 mg (one tablet) twice daily for five to seven days. Presentation should be given with oestrogen.
  • Dysfunctional bleeding (to prevent bleeding): 10 mg (one tablet) twice daily from day 11 to day 25 of the cycle. Presentation should be given with oestrogen.
  • Amenorrhoea: An oestrogen once daily from day 1 to day 25 of the cycle, together with 10 mg Presentation twice daily from day 11 to day 25 of the cycle.
  • Irregular cycles: 10 mg (one tablet) twice daily from day 11 to day 25 of the cycle.
  • Infertility due to luteal insufficiency: 10 mg (one tablet) daily from day 14 to day 25 of the cycle. The treatment should be continued for at least 6 consecutive cycles. It is advisable to continue this treatment during the first month of any pregnancy using the doses stated with respect to habitual miscarriage.
  • Luteal support as part of an Assisted Reproductive Technology (ART) treatment: 10 mg three times daily (three tablets daily) starting at the day of oocyte retrieval and continuing for 10 weeks if pregnancy is confirmed.

Hormone Replacement Therapy: In combination with continuous oestrogentherapy, take one tablet daily for 14 consecutive days of a 28 day cycle. In combination with cyclical oestrogen therapy take one tablet daily during the last 12 to 14 days of oestrogen therapy. For doctors: If endometrial biopsies or ultrasound reveal inadequate Presentationational response, 20 mg Dydrogesterone should be prescribed. For patients: If you are not sure what type of oestrogen therapy you are on, talk to your Doctor before taking Presentation. There is no relevant use of Dydrogesterone before menarche. The safety and efficacy of Dydrogesterone in adolescents aged 12 to 18 years has not been established.

Contraindications of Tablet:-Duphaston 10 mg(AS A Dydrogesterone As a Duphaston As A Female Sex hormones.)

 

Known hypersensitivity to the active substance or to any of the excipients. Known or suspected progestogen dependent neoplasms (e.g. meningioma).

Side Effects of Tablet:-Duphaston 10 mg(AS A Dydrogesterone As a Duphaston As A Female Sex hormones.)

 

The most commonly reported adverse drug reactions of patients treated with Duphaston in clinical trials of indications without oestrogen treatment are migraines/headache, nausea, menstrual disorders and breast pain/tenderness.

Pregnancy & Lactation of Tablet:-Duphaston 10 mg(AS A Dydrogesterone As a Duphaston As A Female Sex hormones.)

 

It is estimated that more than 10 million pregnancies have been exposed to Dydrogesterone. So far there were no indications of a harmful effect of Dydrogesterone use during pregnancy. No data exist on excretion of Dydrogesterone in mother’s milk. Experience with other progestogens indicates that progestogens and the metabolites pass to mother’s milk in small quantities. Whether there is a risk to the child is not known. Therefore Dydrogesterone should not be used during the lactation period.

Therapeutic Class of Tablet:-Duphaston 10 mg(AS A Dydrogesterone As a Duphaston As A Female Sex hormones.)

Female Sex hormones

Injection 2.HPC I/M 250mg/ml 1 ampoule

(As A Hydroxyprogesterone Caproate AS A Hormone preparations for other uses).

Indications of Injection 2.HPC I/M 250mg/ml 1 ampoule

(As A Hydroxyprogesterone Caproate AS A Hormone preparations for other uses).

 

HPC is indicated for-

Reducing the risk of preterm birth in women with a singleton pregnancy who have a history of singleton spontaneous preterm birth

Prevention of preterm labor in a singleton pregnancy for patients aged 16 years or older who have a history of spontaneous preterm birth

Description Injection 2.HPC I/M 250mg/ml 1 ampoule

(As A Hydroxyprogesterone Caproate AS A Hormone preparations for other uses).

 

HPC is a synthetic steroid hormone that is similar to medroxyprogesterone acetate and megestrol acetate. It is an ester derivative of 17a-hydroxyprogesterone formed from caproic acid (hexanoic acid).

Pharmacology Injection 2.HPC I/M 250mg/ml 1 ampoule

(As A Hydroxyprogesterone Caproate AS A Hormone preparations for other uses).

 

The mechanism by which progesterone prevents preterm birth is not well understood, but many pathways are likely involved. (1) Progesterone plays a vital role in regulation of the female reproductive system and is important for successful implantation of the embryo and maintenance of pregnancy. It acts by binding to progesterone receptors in the uterus, ovaries, breasts and in the central nervous system. These receptors exist in 2 isoforms, PR-A and PR-B. Progesterone binding to these receptors ultimately leads to regulation of gene transcription. (2) This results in an anti-inflammatory effect which blunts the proinflammatory state that occurs with initiation of labor, and maintains uterine queiscence by stabilizing progesterone acting on the myometrium.

Dosage & Administration Injection 2.HPC I/M 250mg/ml 1 ampoule

(As A Hydroxyprogesterone Caproate AS A Hormone preparations for other uses).

 

Administer intramuscularly at a dose of 500 mg or 250 mg once weekly. Begin treatment between 16 weeks, 0 days and 20 weeks, 6 days of gestation. Continue administration once weekly until week 37 (through 36 weeks, 6 days) of gestation or delivery, whichever occurs first.

Administration-

  • Clean the ampoule top with an alcohol swab before use.
  • Draw up 1 ml of drug into a 2 ml syringe.
  • After preparing the skin, inject in the upper outer quadrant of the gluteus maximus. The solution is viscous and oily. Slow injection (over one minute or longer) is recommended.
  • Applying pressure to the injection site may minimize bruising and swelling.

Contraindications Injection 2.HPC I/M 250mg/ml 1 ampoule

(As A Hydroxyprogesterone Caproate AS A Hormone preparations for other uses).

 

  • Current or history of thrombosis or thromboembolic disorders.
  • Known or suspected breast cancer, other hormone-sensitive cancer, or history of these conditions.
  • Undiagnosed abnormal vaginal bleeding unrelated to pregnancy.
  • Cholestatic jaundice of pregnancy.
  • Liver tumors, benign or malignant, or active liver disease.
  • Uncontrolled hypertension.

Side Effects Injection 2.HPC I/M 250mg/ml 1 ampoule

(As A Hydroxyprogesterone Caproate AS A Hormone preparations for other uses).

 

Most Common: Injection site reactions (pain, swelling, pruritus, nodule), Hives, Itching, nausea, and diarrhea. Call your doctor if you get any of the symptoms below:

  • Blood clots Symptoms: Leg swelling, Redness in your leg, a spot on your leg that is warm to touch, Leg pain that worsens when you bend your foot.
  • Allergic reactions: Hives, Itching, Swelling of the face.

Pregnancy & Lactation Injection 2.HPC I/M 250mg/ml 1 ampoule

(As A Hydroxyprogesterone Caproate AS A Hormone preparations for other uses).

 

Pregnancy: Category B. No adequate and well-controlled studies in women during first trimester of pregnancy. Teratogenic risks to infants following in utero exposure to the drug not demonstrated in a study of pregnant women receiving the drug during their second and third trimesters, as well as in a follow-up safety study of their infants. Not intended to stop active preterm labor; effect of drug for this use unknown.

Lactation: Detectable amounts of progestins identified in the breast milk of women receiving progestins. No adverse effects of progestins on breastfeeding performance or on health, growth, or development of infants, Discontinue drug at 37 weeks of gestation or upon delivery.

Therapeutic Class Injection 2.HPC I/M 250mg/ml 1 ampoule

(As A Hydroxyprogesterone Caproate AS A Hormone preparations for other uses).

 

Hormone preparations for other uses

Raiyyan Tahsan Date:21-01-2025 Tuesday Time:7-28-55 PM

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