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Progestogen for treating threatened miscarriageWahabi HA, Abed Althagafi NF, Elawad M
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SummaryProgestogen for treating threatened miscarriageThreatened 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.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
July 18. 2007 AbstractBackgroundMiscarriage 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. ObjectivesTo determine the efficacy and the safety of progestogens in the treatment of threatened miscarriage. Search strategyWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 1), MEDLINE (January 1966 to April 2006), EMBASE (1980 to April 2006) and CINAHL (1982 to April 2006). We scanned bibliographies of all located articles for any unidentified articles. We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 27 July 2009 and added the results to the awaiting classification section of the review. Selection criteriaRandomized 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 analysisAt least two authors assessed the trials for inclusion in the review and extracted the data. Main resultsTwo 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 (relative risk 0.47; 95% confidence interval (CI) 0.17 to 1.30). Authors' conclusionsBased 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. [Note: The four citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.] |