Progesterone for threatened miscarriage

DetailsAdditional comments
Review questionWhat is the effectiveness of progesterone in improving outcomes in women with threatened miscarriage?
ObjectivesTo determine the effectiveness of progesterone/progestogen in preventing miscarriage in women indentified with threatened miscarriage
LanguageEnglish
Study designIdeal

Systematic reviews of randomised controlled trials (RCTs)

RCTs

Less ideal

Other comparative studies – only if no RCTs available
There is a study looking into care of women with idiopathic recurrent miscarriage (PROMISE trial) (will not be published by time of publication)
StatusPublished papers
PopulationPopulation includes:

Women diagnosed with threatened miscarriage in the first trimester of pregnancy.
Consider:

Different gestations – very important to identify this is papers reviewed

Differing degrees of bleeding

With and without pain

Absence of ultrasound assessment as before scans appeared. Most studies done in 1960s, including RCTs
InterventionProgesterone therapy / progestogen (any regimen/any route)Route may be important

Several synthetic progestogens were used e.g. Provera, methylhydroxyprogesterone, norethisterone. Other progestogens were manufactured and possibly trialled but no longer used e.g. duphaston
ComparatorNo intervention
OutcomesLive birth

Ongoing viable pregnancy/pregnancy beyond 12 weeks

Adverse effects of treatment including IUGR (intrauterine growth restriction), fetal abnormality and stillbirth. Also obstetric morbidity e.g. pre-eclampsia , placental abruption, pre-term birth,

Need for further interventions (including delayed miscarriage 1–2 weeks later)

Women's views/experiences of care and initial follow-up (maternal satisfaction)/emotional and psychological outcomes of woman and her partner (including depression, anxiety and post-traumatic stress disorder)
Fetal abnormality e.g. limb reduction defects were highlighted as possible adverse events
Other criteria for inclusion/exclusion of studiesExclude developing countries

Exclude women presenting with diagnosed molar pregnancy

From: Appendix D, Review protocols

Cover of Ectopic Pregnancy and Miscarriage
Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage.
NICE Clinical Guidelines, No. 154.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG; 2012 Dec.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

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