Abstract
There has not been conclusive evidence in literature on the efficacy of progestogen
in the treatment of threatened miscarriage, although some studies showed benefits.
In our centre, threatened miscarriage is treated with either micronised progesterone
(MP) or dydrogesterone (DYD).
Objective
The aim of this study is to compare clinical outcomes of miscarriage, extent of vaginal
bleeding at follow-up and side effects between treatment groups.
Study design
This study was a prospective parallel-group, open-label, randomized controlled trial.
141 women presenting with threatened miscarriage were randomised to either MP or DYD
of which 118 were included in the analysis. Baseline maternal demographics and serum
progesterone levels were collected at presentation. Post-treatment bleeding pattern
and self-reported side effects were recorded at the follow-up visit (on day 4–10 of
treatment). The occurrence of spontaneous miscarriage was ascertained at week 16 of
gestation.
Results
The population with miscarriage and resolution of bleeding were not statistically
different between MP and DYD groups. A significantly higher percentage of women treated
with MP reported drowsiness (p = 0.003). After stratification into low and high serum
progesterone levels, a significantly higher miscarriage rate was found in the low
progesterone group, regardless of treatment type.
Conclusion
In conclusion, extent of bleeding at day 4–10 and subsequent miscarriage rates were
comparable between MP and DYD groups. However, fewer patients treated with DYD reported
drowsiness and giddiness. The finding of significantly higher miscarriage rates in
women with low progesterone levels despite treatment is an important factor to consider
in counselling and prognosticating pregnancy outcomes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology.Fertil Steril. 2009; 92: 1520-1524
- Pregnancy losses in young Australian women: findings from the Australian Longitudinal Study on Women’s Health.Women Health Issue. 2009; 19: 21-29
- Genes, chromosomes and reproductive failure.Fertil Steril. 1980; 33: 107-116
- Embryonic karyotype of abortuses in relation to the number of previous miscarriages.Fertil Steril. 2000; 73: 300-304
- Genetic factors as a cause of miscarriage.Curr Med Chem. 2010; 17: 3431-3437
- Reproductive success and failure.in: Cunningham F.G. Wenstrom K. Hauth J. Leveno K. Gilstrap L. Williams obstetrics. 21st ed. McGraw-Hills, New York2001: 853-855
- Fetal loss following ultrasound diagnosis of a live fetus at 6–10 weeks of gestation.Ultrasound Obstet Gynecol. 2003; 22: 368-372
- A prospective study of risk factors for first trimester miscarriage in Asian women with threatened miscarriage.Singapore Med J. 2013; 54: 425-431
- Physiology of pregnancy.in: Cunningham F.G. Wenstrom K. Hauth J. Leveno K. Gilstrap L. Williams obstetrics. 21st ed. McGraw-Hills, New York2001: 63-65
- The role of progesterone in human early pregnancy is mediated by insulin-like growth factors binding protein1-3.Sichuan Da Xue Xue Bao Yi Xue Ban. 2006; 37 (Chinese): 399-403
- Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding:meta-analysis of cohort studies.Br Med J. 2012; 345 (Web): e6077
- How can we better predict the risk of spontaneous miscarriage among women experiencing threatened miscarriage?.Gynecol Endocrinol. 2015; 31: 647-651
- Validation of serum progesterone <35 nmol/L as a predictor of miscarriage among women with threatened miscarriage.BMC Pregnancy Childbirth. 2017; 17: 78
- Progestins.Maturitas. 1996; 23: 13-18
- Selectivity and potency of the retroprogesterone dydrogesterone in vitro.Steroids. 2011; 76: 607-615
- Progestogen for treating threatened miscarriage (Review).Cochrane Database Syst Rev. 2011; 12 (Art. No.: CD005943)https://doi.org/10.1002/14651858.CD005943.pub4
- A systematic review of dydrogesterone for the treatment of threatened miscarriage.Gynecol Endocrinol. 2012; 28: 983-990
- European Progestin Club Guidelines for prevention and treatment of threatened or recurrent (habitual) miscarriage with progestogens.Gynecol Endorinol. 2015; 31: 447-449
- Absorption of oral progesterone is influenced by vehicle and particle size.Am J Obst Gynecol. 1988; 159: 1203-1209
Article info
Publication history
Published online: July 25, 2018
Accepted:
July 24,
2018
Received in revised form:
June 23,
2018
Received:
April 4,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
