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A Combination Treatment of Prednisone Aspirin Folate and Progesterone in Women With Idiopathic Recurrent Miscarriage
A Combination Treatment of Prednisone Aspirin Folate and Progesterone in Women With Idiopathic Recurrent Miscarriage
A Combination Treatment of Prednisone Aspirin Folate and Progesterone in Women With Idiopathic Recurrent Miscarriage
A Combination Treatment of
Prednisone, Aspirin, Folate, and
Progesterone in Women with
Idiopathic Recurrent
Miscarriage
A Matched-Pair
Study
Clement B. Tempfer, M.D., Christine Kurz, M.D., Eva-Katrin Bentz,
M.D., Gertrud Unfried, M.D.,
Katharina Walch, M.D., Ullrike Czizek, and Johannes C. Huber, M.D.,
Ph.D.
Introduction
Recurrrent miscarriage :
3 consecutive pregnancy losses with the same partner
before 20weeks gestation
A standar diagnostic workup including :
Hysteroscopy
paternal & maternal karyotype
cervical culture for chlamydia, ureaplasma, & mycoplasma
A comprehensive hormonal status
Evaluation APS with IgM & IgG anticardiolipin antibody
assessment & lupus anticoagulant testing
40 60% are found to have none of these pathologies
Idiopathic Recurrent Miscarriage (IRM)
Fertility and Sterility Vol. 86, No.1, July 2006
contrary
Laskin compared
prednisone (0.5-0.8
mg/kg) + aspirin
(100 mg/d)
placebo
in 202 women no
difference in live
birth rates
contrary
In addition, a
systematic review of
5 controlled studies
on prednisone and
aspirin in women
with IRM found no
decrease in
miscarriage rates
Objective
This study was undertaken to compare a
combination treatment of prednisone,
aspirin, folate, & progesterone with no
treatment in women with IRM
folate
prednisone
IRM
progesterone
aspirin
Fertility and Sterility Vol. 86, No.1, July 2006
Treatment
All women with IRM were asked to participate
in a prospective mathced-pair study to evaluate
a combination treatment consisting of :
Progesterone (20 mg/d)
First 12w
IRM
Folate (5 mg/d)
210
210 Consecutive
Consecutive women
women
With
With recurrent
recurrent miscarriages
miscarriages
Flow Charts
80
80 women
women
Gave
informed
Gave informed consent
consent
130
130 women
women
Did
not
participate
Did not participate
52
52 women
women
Became
Became pregnant
pregnant
67
67 women
women
Become
Become pregnant
pregnant
52
52 women
women
Used
Used as
as controlls
controlls
40
40 live
live birth
birth
10
10 first
first trimester
trimester miscarriages
miscarriages
00 second
trimester
second trimester miscarriage
miscarriage
18
18 live
live birth
birth
11 ectopic
ectopic pregnancy
pregnancy
11 was
terminated
was terminated due
due to
to fetal
fetal
chromosome
chromosome abberation
abberation
33
33 first
first trimester
trimester miscarriages
miscarriages
11 second
trimester
second trimester miscarriage
miscarriage
Statistical Analysis
Variables of interest were described by
median, range, mean, & standard deviation in
case of skewed & normal distributions,
respectively
Differences between categorical variables
were compared by X2 test
Differences between paired continuous
variables were assessed by paired t-test after
checking for deviations of normality of
distribution according to Shapiro & Wilk
Fertility and Sterility Vol. 86, No.1, July 2006
Results
80 women
Gave informed consent
130 women
Did not participate
52 women
Became pregnant
67 women
Become pregnant
52 women
Used as controls
52 women
Became pregnant
67 women
Became pregnant
52 women
Used as controls
40 live birth
16 live birth
1 ectopic pregnancy
1 was terminated due to fetal
Chromosome abberation
Miscarriage :
1st trimester : 19% & 63% (p=.09)
2nd trimester : 0% & 2% (p=1.0)
Fertility and Sterility Vol. 86, No.1, July 2006
Discussion
Progesterone (20 mg/d)
First 12w
IRM
Eve
ry s
e
Folate (5 mg/d)
con
d da
In accordance with data by Reznikoff-Etievant suggesting that prednisone treatment limited to the
1st trimester may be effective , while not being associated with an increased rate of side effect
Fertility and Sterility Vol. 86, No.1, July 2006
dosage
duration
Conclusion
This study indicate that combinatiion
treatment consisting of high-dose, lowduratiion
prednisone
&
aspirin,
progesterone, and folate might be
effective treatment for women with IRM
Critical Appraisal
Several limitations
1. The number of participants included in this study is low
2.
3.
No, the study just collect some important & accordant data for
statistical analysis to objective of study
Fertility and Sterility Vol. 86, No.1, July 2006
Yes, I can apply the study findings for managing women with IRM
Fertility and Sterility Vol. 86, No.1, July 2006
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Thank You !