Drazancić A, Latin V
Jugosl Ginekol Opstet. 1978 May-Aug;18(3-4):325-33.
The results of the treatment of 151 pregnancies with threatened and/or habitual abortions by using high hormonal dosages (Gravibinan "Alkaloid") are presented. Eight pregnancies were in primigravidas, the remaining 143 patients having previously had 47 interruptions of pregnancy, 66 deliveries, and 313 spontaneous abortions. Disregarding artificial abortions in 379 previous pregnancies there were 313 or 82.5 per cent spontaneous abortions. The treatment was performed by i. m. applications of Gravibinan, during the first week every two days, during the following two weeks every three days, and until the accomplished 16 weeks of pregnancy every five days. Besides hormonal therapy, all patients were on bed rest; in the following course of pregnancy tocolysis and in the case of opened cervix the cerclage cervicis were performed. The vitality of the ovum and the fetus, as well as the efficacy of the treatment were evaluated by clinical findings, HCG and estriol urinary eliminations, and by ultrasonography. Out of 151 treated pregnancies, 21 (13.91%) resulted in early abotion, 17 (11.26%) in mid-trimester abortion, 6 (3.97%) in pre-term, and 107 (70.86%) in term deliveries. There were two (1.77%) perinatally dead premature infants. HCG urinary eliminations were significantly lower in pregnancies resulting is missed abortion or first-trimenon miscarriage, whereas no difference was established between pregnancies resulting in delivery or mid-trimester abortion. The authors recommend hormonal treatment in early threatening and/or habitual abortions by administering high dosages of estrogens and gestagens. Such a treatment stimulates secretory transformation of the endometrium at the beginning of pregnancy, and this allows early placentation and the uterine growth with a simultaneous quiescence of the myometrium, which, in turn, makes the growth of the ovum possible. The authors stress the importance of a complex procedure in the establishment of the etiology and in the treatment of spontaneous and/or habiutal abortion.
本文介绍了使用高剂量激素(“生物碱”格拉维宾)治疗151例有先兆流产和/或习惯性流产的妊娠情况。8例为初产妇,其余143例患者既往有47次妊娠中断、66次分娩和313次自然流产。不考虑之前379次妊娠中的人工流产,自然流产有313次,占82.5%。治疗方法是肌肉注射格拉维宾,第一周每两天注射一次,接下来两周每三天注射一次,直到妊娠满16周每五天注射一次。除激素治疗外,所有患者均卧床休息;在妊娠后期进行安胎治疗,宫颈口开放时进行宫颈环扎术。通过临床检查、尿中HCG和雌三醇排泄量以及超声检查来评估卵子和胎儿的活力以及治疗效果。在151例接受治疗的妊娠中,21例(13.91%)早期流产,17例(11.26%)中期流产,6例(3.97%)早产,107例(70.86%)足月分娩。有2例(1.77%)围产期死亡的早产儿。发生稽留流产或孕早期流产的妊娠中尿HCG排泄量显著较低,而在分娩或中期流产的妊娠之间未发现差异。作者建议在早期先兆流产和/或习惯性流产时通过给予高剂量雌激素和孕激素进行激素治疗。这种治疗在妊娠开始时刺激子宫内膜的分泌转化,从而实现早期胎盘形成和子宫生长,同时使子宫肌层静止,进而使卵子能够生长。作者强调在确定病因以及治疗自然流产和/或习惯性流产时采用综合程序的重要性。