for the use only of a registered medical
practitioner or a hospital or a laboratory.
TREATMENT OF
THREATENED & RECURRENT ABORTIONS
(A Clinical Study of 62 cases with `LEPTADEN)
Dr. (Mrs.) K. ACHARI, M.S., M.R.C.O.G. Lecturer in Obstetrics and Gynacology,
Patna Medical College, and
Dr. RENU SINHA, M.B.B.S. (Hon.) Rajendra Nagar Hospital, Patna
The Patna Journal of Medicine,
Vol. XXX No. 1. P.1-3 Jan. 1966
The treatment of threatened and
recurrent abortion occurring during the first 20-22 weeks of pregnancy is very
unsatisfactory as often no cause can be discovered. Even when local; and
general -causes are excluded, there is still a large number of cases
to be accounted for etiological factors. It is in such cases that hormone
deficiency is postulated as an important cause. And Progesterone is commonly
used empirically, with varying degrees of success to preserve pregnancy.
Increasing
knowledge of hormone activity and understanding of possible causes of abortions
give a hope for improvement in treatment. Till then the treatment has to be
symptomatic with hormones, vitamins. Restoration of confidence in the patients
is the most significant part of management of these patients.
The
present clinical trials with a herbal drug - LEPTADEN - were undertaken
'against this background of rather unsatisfactory treatment available at
present in threatened and recurrent abortions during the first 20-22 weeks of
pregnancy.
MATERIAL AND METHODS
The patients in this series were selected
from those who attended eithbr the Hospital for Women, Patna Medical College
Hospital, Patna or the private clinics of the authors during the year 1964.
Drug: Leptaden (Alarsin) was selected for these trials. .
It is a herbal drug and each tablet consists of;
Jeevanti (Leptadenia reticulata) 150 mg.
Kamboji (Breynia patens) 150
mg.
The mode of
action of this drug is not known. It may perhaps be acting as a uterine
sedative either by direct action or through the hormone mechanism.
Its
usefulness in threatened and habitual abortions was first suggested by Patel.
Manageshikar (1957) has reported encouraging results in a trial of 26 cases
of habitual abortions with LEPTADEN.
Dose: 1) Leptaden: 2
tablets t.d.s. were given throughout pregnancy. 2) Progesterone (depot) 125 mg.
I.M. was given once a week till 22nd week of pregnancy.
They did not receive any other hormone treatment. They had
sedative, bed rest and avoidance of sexual intercourse or excitement.
THREATENED ABORTION
There were 40 cases of threatened abortion between 6-22
weeks of pregnancy. Each of them had one bout of bleeding before admission 'to
the hospital or clinics. The following criteria was fulfilled before taking the
case for this trial.
(1) Normal anatomy of the
uterus and cervix according to the period of gestation
(2)
Exclusion of general etiological factors
(3) Absence
of incompetent OS
(4) Negative serological test.
The results were as shown in Table I.
TABLE -I Results
of Leptaden therapy in 40 cases of threatened 'abortion
|
Amenorrhoea in weeks |
No. of Cases |
Abortion
|
Pregnancy continued by22nd weeks |
Full term delivery |
|
6-10 |
10 |
3(30%) |
7(70%) |
7(50%) |
|
10-16 |
16 |
6(37.5%) |
10(62.5%) |
10(62.5%) |
|
16-22 |
14 |
7(50%) |
7(50%) |
7(50%) |
.
Table I indicates that if the
treatment is started from early pregnancy the results are likely to be better.
RECURRENT ABORTION
12 cases were taken from the private clinics of the authors and 10 cases were taken from the hospital series. In all 22 cases between 2030 years age group who could give a reliable history of one or more consecutive and spontaneous abortions before 20th week of pregnancy were selected. All cases with abnormal anatomy of cervix, size of uterus which did not correspond with amenorrhoea were excluded. Cases who had some general etiological factors as probable cause of abortion or in whom were found complicating factors such as associated medical diseases of obvious potential significance were also excluded.
TABLE –II
Results of 22 cases of recurrent abortions with Leptaden treatment
Previous No. of Abortion
Pregnancy Full term
Abortion Cases Proceeded delivery
1 Abotion 8 2(25%)
6 6(75%)
2 Abortions ' 6 2(33.5%) 4 3(66.5%)
3 or more 8 3(37%) 5 4(50%)
DISCUSSION
It is difficult to estimate the result of treatment in these cases because
it has been found that even after repeated abortions a pregnancy often goes to
full term without any general or specific treatment. Because of the uncertainty
about prognosis of a case of threatened or recurrent abortion several types of
treatments have been advocated and gained clinical popularity in different
hands at different times:
Where
faulty germ plasm or improper maternal environment is the most predominant
cause of habitual abortion no therapy-hormone or other - is likely to be
helpful. Also in bleeding of placenta previa abortion after 22 weeks of pregnancy,
very little can be offered by way of treatment.
The most
striking feature of reports in recent literature (Bicharch 1940, Smith 1948,
Bavis 1,951, Bishop and Richard 1952) is the uniformity of results
claimed for various methods of treatments. As they clearly all indicate a success
rate of the order of about 80% it is rather surprising that management of
threatened and recurrent abortions should still be considered a burning problem
and its treatment as uncertain and unsatisfactory! And real doubt arises
whether prognosis for the untreated patients may not be much better than was
generally supposed!
An
alternative explanation would be that psychic factors are of paramount
importance and that all the treatments are effective simply by giving the
needed psychological boost to create confidence in the drug and other measures
adopted.
When there is definite history of threatened or recurrent abortion, the
treatment should start from preconception period. Any specific medical or
gynaecological cause should be detected, and treated before conception, it is
worth considering if use of Leptaden in preconception period is likely to give
better results particularly when its administration is simple and safe.
CONCLUSIONS
In our series of 62 cases of threatened and recurrent abortion of
idiopathic origin and occuring before 20-22 weeks of pregnancy Leptaden with
Progesterone seem to have brought down the incidence of recurrent abortion.
Safe and simple dosage of Leptaden is an additional advantage for its use
throughout pregnancy.
ACKNOWLEDGEMENT
Our
thanks are due to Prof. S. N. Upadhyay, MD., FRCOG., FiCS., FACS., who gave us
valuable suggestion and help.
Our
thanks are due to Alarsin Pharmaceuticals, Bombay 1, for supplying Leptaden
tablets for this trial.
REFERENCES
1. Bacharch, A. L., Brite. Med. Jour., 1.890, 1970.
2. Bevis, D. C. A.,
Lencet, 2.207,1951.
3. Bishop, P. M. F., Guy's Hosp. Rep.
87.367, 1937.
4. Bishop, and Richards, N. A., Brit. Med. Jour.,
1.244,1952.
5. Jones, G. E.
S. and Delfs, E., J. Amer Med. Ass. 149.1212,1951.
6. Malpas; P., J. Obstet. Gynaec. Brit. Emp.,
45.932,1938.
7.
Mangeshikar, S. N., Paper read at the All India Med. Conf. (Personal Comm.)
1957. 8. Osmand-Clark, F. & Murray, M., Brit. Med. J.,1.307,1958.
9. Patel, N. V., The
Antiseptic, 15.6,1947. 10. Somervillie, IF., Marrian, G. F. and Kellar, R. 10.
J. Lancet, 2.89, 1948.
11. Swayer, G. I. M., Lancet,
1.104,1949.
12. Swayer, G. I. M. & Daley, Doreen, Brite. Med. Jour., 1.1073,1953.
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