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Progestogen for treating threatened miscarriage

  • Review
  • Intervention

Authors


Abstract

Background

Miscarriage is a common complication encountered during pregnancy. The role of progesterone in preparing the uterus for the implantation of the embryo and its role in maintaining the pregnancy have been known for a long time. Inadequate secretion of progesterone in early pregnancy has been linked to the aetiology of miscarriage and progesterone supplementation has been used as a treatment for threatened miscarriage to prevent spontaneous pregnancy loss.

Objectives

To determine the efficacy and the safety of progestogens in the treatment of threatened miscarriage.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2009) and bibliographies of all located articles for any unidentified articles.

Selection criteria

Randomized or quasi-randomized controlled trials that compare progestogen with placebo, no treatment or any other treatment given in an effort to treat threatened miscarriage.

Data collection and analysis

At least two authors assessed the trials for inclusion in the review and extracted the data.

Main results

Two studies (84 participants) were included in the meta-analysis. In one study, all the participants met the inclusion criteria and in the other study, only the subgroup of participants who met the inclusion criteria was included in the meta-analysis. There was no evidence of effectiveness with the use vaginal progesterone compared to placebo in reducing the risk of miscarriage (risk ratio 0.47; 95% confidence interval 0.17 to 1.30).

Authors' conclusions

Based on scarce data from two methodologically poor trials, there is no evidence to support the routine use of progestogens for the treatment of threatened miscarriage. Information about potential harms to the mother or child, or both, with the use of progestogens is lacking. Further, larger, randomized controlled trials on the effect of progestogens on the treatment of threatened miscarriage, which investigate potential harms as well as benefits, are needed.

Plain language summary

Progestogen for treating threatened miscarriage

Threatened miscarriage is when a mother might be losing her baby at less than 23 weeks' gestation. The signs are vaginal bleeding, with or without abdominal pain, while the cervix is closed. Once the cervix begins to open, miscarriage and pregnancy loss are inevitable. Miscarriage is common, happening in about 15% to 20% of pregnancies, and it can cause emotional problems in terms of depression, sleep disturbances, anger, etc. Miscarriage can also be associated with excessive bleeding and shock, and in low-income countries sometimes causes maternal death, though this is very rare in high-income countries. Progestogen is an essential hormone for establishing and maintaining pregnancy, and so is therefore thought to be a possible treatment for threatened miscarriage. The review of trials located just two studies, involving 84 women, that met the entry criteria but they were still poor quality studies. Hence, there is insufficient evidence to assess if progestogen is an effective treatment for threatened miscarriage. Any future studies should not only look at the possible impact on miscarriage and pregnancy, but also need to check there are no adverse effects on the baby.

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