The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion: A Systematic Review and Meta-Analysis

Abstract

Objective To conduct systematic analyses to evaluate the efficacy of progesterone therapy for the prevention of miscarriages in pregnant women experiencing threatened abortion. Methods In November 2016, we performed a systematic literature search and identified 51 articles in PubMed, Embase, and Cochrane databases. We identified nine randomized trials that included 913 pregnant women (including 322 treated with oral dydrogesterone, 213 treated with vaginal progesterone, and 378 control subjects) who met the selection criteria. Results The incidence of miscarriage was significantly lower in the total progesterone group than in the control group (13.0% versus 21.7%; odds ratio, 0.53; 95% confidence interval (CI), 0.36 to 0.78; P = 0.001; I2, 0%). Moreover, the incidence of miscarriage was significantly lower in the oral dydrogesterone group than in the control group (11.7% versus 22.6%; odds ratio, 0.43; 95% CI, 0.26 to 0.71; P = 0.001; I2, 0%) and was lower in the vaginal progesterone group than in the control group, although this difference was nonsignificant (15.4% versus 20.3%; odds ratio, 0.72; 95% CI, 0.39 to 1.34; P = 0.30; I2, 0%). However, the incidence of miscarriage was not different between the oral dydrogesterone and vaginal progesterone groups. Conclusion Progesterone therapy, especially oral dydrogesterone, can effectively prevent miscarriage in pregnant women experiencing threatened abortion.

The efficacy and safety of dydrogesterone for treatment of dysmenorrhea: An open‐label multicenter clinical study

“…This can be one of the mechanisms of the various beneficial effects of dydrogesterone. Moreover, the results of a systematic review and a randomized controlled trial indicated that the oral dydrogesterone therapy can effectively prevent threatened miscarriage in pregnant women …”

Routine Progesterone Supplementation in Threatened Abortion: Is It a Sound Practice?

“…(2017) in their mata-analysis stated that the incidence of abortion was significantly reduced in the progesterone group than in the control group (13.0% versus 21.7%) [14]. On the other hand, Duan et al (2010) in their study compared intramuscular progesterone to no treatment in threatened abortion.…”

Effect of progestogen for women with threatened miscarriage: a systematic review and meta‐analysis

“…Previous meta-analyses did not assess the effect of progestogen on live birth. 12,13 In those reviews, miscarriage was the primary outcome. Lee et al found that progestogen therapy can effectively reduce miscarriage events in pregnant women experiencing threatened miscarriage (RR 0.53, 95% CI 0.36-0.78).…”

“…[4][5][6][7][8][9][10][11] Previous systematic reviews and meta-analyses suggested that progestogen may reduce the risk of miscarriage in pregnant women with threatened miscarriage. 12,13 However, these reviews only included small trials with several hundred women and were thus limited in statistical power. Moreover, these reviews did not assess the rate of live birth, which is the most important clinical outcome for pregnancy.…”