The Safety of Proctofoam-HC in the Third Trimester of Pregnancy

Hemorrhoids are a frequent condition in pregnancy. The rate is increased as pregnancy progresses, and they affect up to 24% of pregnant women in the third trimester. Complications of untreated hemorrhoids include bleeding, prolapse, soiling, discharge with perianal irritation and itching, and in severe cases, severe pain and venous engorgement which could even lead to thrombosis and infarction. Hemorrhoids are treated with a variety of suppositories and gels, based on analgesic and anti-inflammatory effects. The safety of these antihemorrhoidal products has not yet been documented in pregnant women.

Proctofoam-HC® has been on the Canadian market for 25 years. It combines the anti-inflammatory action of hydrocortisone with the surface anesthetic effect of pramoxine HCl. It is approved for temporary relief of anorectal inflammation, pruritus, pain and swelling associated with haemorrhoids, fissures, pruritus ani, cryptitis, proctitis and postoperative pain.

We hypothesize that local application of Proctofoam-HC® in the third trimester of pregnancy is safe for the mother and fetus.

Inclusion criteria

• For intervention group, any pregnant woman with a primary anorectal condition during the third trimester of pregnancy
• For control group, women in third trimester of pregnancy not treated with Proctofoam, and matched on maternal age and smoking status
• for either group,no other pregnancy complications

Exclusion criteria

• exposure to known teratogens during pregnancy as evident either during the prenatal or postnatal interview
• insufficient English language skills to understand the questionnaires and assessment material
• Women who have received other corticosteroid medications (systemic or topical)during pregnancy
• Women with the following conditions: abscess, fistula, tuberculosis, varicella, acute Herpes Simplex or fungal infection
• age less than 18 years
• History of previous reaction to any of the product's components, such as: local irritation, hypertrichosis, hypopigmentation, etc.
• Known Intrauterine Growth Restriction (IUGR) or a chronic state that may cause IUGR (SLE, placental insufficiency).
• Multi fetal pregnancy
• Binge alcohol consumption (5 or more drinks on one occasion,in a row or within a short period of time)