The Effectiveness of Adrenocorticotropin Repeated Doses in High Risk PregnanciesKlimek M.
Department of Gynecology and Infertility Clinic of Jagiellonian University, Krakow, Poland
Objective: The aim of this study was to assess the effect of two kinds of adrenocorticotropin (ACTH)-depot repeated doses administered to pregnant women who underwent infertility treatment. Material and Methods: The study population included 424 pregnant women with singletons. Two hundred and forty-two women received repeated 0.5 mg doses of ACTH, whereas 182 women also were treated for infertility but did not receive any therapy. The ACTH-treated patients were subdivided into two subgroups: (1) 142 patients received only series of three 0.5 g ACTH-depot injections every other day in the first and/or second trimester with occasionally single ACTH-depot doses in the third trimester, (2) 100 patients received only single 0.5 mg ACTH-depot doses for the entire duration of pregnancy. Clinical symptoms of threatened abortion and preterm delivery as well as very low or decreasing levels of serum oxytocinases were indications for the hormonal therapy. Low oxytocinase serum levels, recurrent abortion and preterm delivery characterize pregnant women with hypothalamic insufficiency. Results: Women who received only single doses of the ACTH-therapy for the entire duration of pregnancy had a statistically significant longer gestation, and higher newborn mass and length than patients who received a series of three hormonal injections as well as control women who had no clinical or laboratory indication for such therapy. Conclusions: ACTH-depot injection results in the oxytocinase increased serum level, a decreased number of abortion and preterm deliveries and prolonged duration of pregnancy. Single repeated doses of the ACTH-depot therapy had statistically significant better results in the prolongation of pregnancy, newborn mass and length than a serial hormonal dosage.
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