Presentation for Progesterone Amp. 100 mg/ml and Progesterone pessaries 400mg for treatment of PTB, Recurrent miscarriage, Threatened abortion, Post-natal psychosis.

1. Progesterone ® Ampoules 100mg / 2ml Rectal and Vaginal Pessaries 400mg

3. What do you know about the menstrual cycle?

4. What is the definition of Preterm birth (PTB), Miscarriage, Puerperal depression, Luteal insufficiency ?

5. What do you know about progesterone and its role?

9. After the point of "fertilization", it is referred to as an egg. The fusion of male and female gametes usually occurs through the act of sexual intercourse.

18. Menstrual cycle diagram 2

21. preterm birth is the major cause of neonatal mortality in developed countries.

22. Premature infants are at greater risk for short and long term complications, including disabilities and impediments in growth and mental development.

23. Signs and symptoms:such signs consists of four or more uterine contractions in one hour before 37 weeks' gestation.

25. Preterm-premature babies ("preemies" or "premies") have an increased risk of death in the first year of life (infant mortality), with most of that occurring in the first month of life (neonatal mortality)

28. PTB risk factors: 1- Maternal Background. 2- Factors during pregnancy.

29. 1- Maternal Background. A number of factors have been identified that are linked to a higher risk of a preterm birth: 1-Low socio-economic or educational standing and single motherhood. 2- Age at the upper and lower end of the reproductive years be it more than 35or less than 18 years of age. 3-Pregnancy interval makes a difference as women with a 6 months span or less between pregnancies have a two-fold increase in preterm birth.

30. 1- Maternal Background. 3- Stressful conditions, hard labor, and long hours are probably linked to preterm birth. 4- Patients who had undergone previous induced abortions. 5- Adequate maternal nutrition is important. Women with a low BMI are at increased risk for preterm birth. 6-Women with a previous preterm birth are at higher risk for a recurrence at a rate of 15–50%. depending on number of previous events and their timing

31. 1- Maternal Background. 7- Uterine malformation, hypertension and diabetes are also a risk factors of a preterm delivery.

32. 2- Factors during pregnancy 1- Multiple pregnancies (twins, triplets, etc.). The March of Dimes Multicenter Prematurity and Prevention Study found that 54% of twins were delivered preterm vs. 9.6% of single births. 2- The use of fertility medication that stimulates the ovary to release multiple eggs. 3- Maternal medical conditions. 4- Weak or short cervix. 5- Uterine malformations. 6- Vaginal bleeding during pregnancy.

33. 2- Factors during pregnancy 7- Women with abnormal amounts of amniotic fluid ,too much (polyhydramnios) or too little (oligohydramnios). 8- The mental status of the women is of significance. Anxiety and depression have been linked to preterm birth. 9- the use of tobacco, cocaine, and excessive alcohol during pregnancy. 10- Infections play a major role in the genesis of preterm birth and may account for 25–40% of events.

34. How to Diagnose PTB? 1- Fetal fibronectin the presence of this glycoprotein in the cervical or vaginal secretions indicates that the border between the chorion and deciduas has been disrupted. A positive test indicates an increased risk of preterm birth.

37. How can you treat PTB? 1- Cervical cerclage. 2- Progesterone medications.

40. Structural Cause

41. Immunological Cause

42. Other Causes and

45. What do you know about Puerperal depression ?It may be named Postpartum depression too. Symptoms: euphoria, overactivity, decreased sleep requirement, flight of ideas, increased sociability, irritability, with highly disorganised speech, Others have severe depression, verbal hallucinations, emotions like extreme fear.

47. What is progesterone ? Progesterone definition : A steroid hormone, secreted by the corpus luteum of the ovary and by the placenta, that acts to prepare the uterus for implantation of the fertilized ovum, to maintain pregnancy, and to promote development of the mammary glands.

48. Progesterone uses: A drug prepared from natural or synthetic progesterone, used in the prevention of miscarriage, PTL, Puerperal psychosis, in the treatment of menstrual disorders, and as a constituent of some oral contraceptives.

49. What are the Sources of progesterone? 1-Plant (Dioscoreamexicana). It contains a steroid called diosgenin that is taken from the plant and is converted into progesterone. 2- Mammals, progesterone, like all other steroidhormones, is synthesized from pregnenolone which is derived from cholesterol. 3- Chemically or synthetic prepared progesterone inside labs.

52. Maintains cervical length.

53. Blocks prostaglandin induced labor.

55. Progesterone success records in cases with short cervical length <15 mm: Cervix study by Dr. Nicolaides & colleagues. N= 250 Progesterone used from the 24th to the 34th week. Progesterone shown a remarkable decrease in the recurrent PTB cases especially with short cervix, also Progesterone has shown a reduction in NEONATAL MORBIDITY as well.

56. Top ranked (LS) treatment: Bio - identical progesterone vs other single agents or combinations in Luteal phase supporting (LS) in IVF/ICSI(26): The success rates of Progesterone single treatment Vs. Other single agents or combinations used as LS medications.

57. SOGC technical update: Recurrent PTB & short cervix cases (<15mm) could be used as indications for progesterone prophylaxis.

58. Indications & Dosage

59. INDICATIONS & DOSAGE: Progesterone is used to support pregnancy in Assisted Reproductive Technology (ART) cycles such as In- vitro Fertilization (IVF): Daily single intramuscular 100mg injection of (PIO) or daily rectal or vaginal pessary 400mg from day of transfer of the embryo, or day 15th till the 8th - 16th week of gestation as progesterone secretion from the placenta is stabilized.

60. INDICATIONS & DOSAGE: Recurrent miscarriage & threatened Abortion: Luteal phase defects may lead to recurrent miscarriage Which may be due to several causes like chromosomal, structural, Immunological or Hormonal cause which is the most common one. dose: starting with single daily intramuscular (100mg) then Progesterone 400mg rectal or vaginal pessary till 8th - 16th week of pregnancy as the placental progesterone secretion is stabilized.

61. INDICATIONS & DOSAGE: Progesterone dosing in PTL: Progesterone intramuscular injection 100mg every other day from the 24th - 34th week of gestation.

62. INDICATIONS & DOSAGE: Treatment of puerperal depression: the recommended dose is 200 - 400 mg per day for seven days after delivery.

64. Why Progesterone® ? 1-Flexibility: Suitable for RECTAL and VAGINAL administration The venous mesh created by the vaginal and rectal vein blood is in close contact with the uterine artery. so counter - current transfer of the absorbed Progesterone form the rectal vein and the vaginal vein as well to The Uterine artery will take place.

65. Why Progesterone® ? 2-Excellent bioavailability: A- Progesterone® has maximum bioavailability within the shortest T ½, as its crystal size is < 10 microns

66. Why Progesterone® ? B- Progesterone® pessaries is characterized by its excellent base (witepsol H 15) with a unique physical properties: 1-Completely Melts at normal body temperature leaving no residuals (and this accounts for the unique absorbability, bioavailability and the excellent results of Progesterone). 2-Has a suitable consistency leading to a uniform distribution of the A.C through all the units thus allowing maximum gradual absorption.

69. Thanks Ladies &Gentlemen Progesterone ® Ampoules 100mg / 2ml Rectal and Vaginal Pessaries 400mg