Dydrogesterone and bed rest vs. bed rest alone in the management of hemorrhage.
- Author:
Ramon M GONZALEZ
- Publication Type:Journal Article, Original
- MeSH: Human; Female; Dydrogesterone; Progesterone; Pre-eclampsia; Bed Rest; Hypertension, Pregnancy-induced; Abortion, Spontaneous; Uterine Hemorrhage; Chorion; Fetal Death
- From: Philippine Journal of Obstetrics and Gynecology 2013;37(3):117-124
- CountryPhilippines
-
Abstract:
Subchorionic hemorrhage is a common sonographic feature during early pregnancy. It appears as a hypoechoic area (half moon or rocket shape) between the chorion and uterine wall. It can be seen as early as 9 weeks until 20 weeks AOG. The most common presenting feature of subchorionic hemorrhage is vaginal bleeding. Some however, are asymptomatic. Clinical significance of subchorionic hemorrhage remains controversial. Some studies conducted showed association of subchorionic hemorrhage with spontaneous abortion, preterm delivery, pre-eclampsia, pregnancy-induced hypertension and placental abnormalities. Recent management options for subchorionic hemorrhage are bed rest and progesterone supplementation. Data on bed rest are limited. Studies on the use of progesterone in subchorionic hemorrhage is also limited. But because of the risk of spontaneous abortion, most clinicians opt to give progesterone to prevent abortion. A total of 210 patients were included in the study. Subjects were randomly assigned to either the bed rest group or dydrogesterone plus bed rest group. Results showed that after two weeks of treatment, 44 patients (41.5%) had resolution of subchorionic hemorrhage after receiving dydrogesterone while 48 patients (46.2%) resolved in the bed rest group. A total of 2 early fetal demise were noted on each arm. For patients treated with dydrogesterone and bed rest, 62 still had subchorionic hemorrhage and 56 of the patients with bed rest alone, still had subchorionic hemorrhage. There is no significant difference in the mean measurement of subchorionic hemorrhage of patients under the two groups who still have it, after two weeks of treatment. Management of subchorionic hemorrhage with dydrogesterone plus bed rest and bed rest alone in patients does not resolve the hemorrhage and does not reduce the incidence of abortion.