<p>The Role Of Progestogens In Threatened And Idiopathic Recurrent Miscarriage</p>

Abstract

It is well known that progesterone plays a major role in the maintenance of pregnancy, particularly during the early stages, as it is responsible for preparing the endometrium for implantation and maintenance of the gestational sac. The management of pregnant women at risk of a threatened or idiopathic recurrent miscarriage is complex and critical. Therefore, a group of obstetricians and gynecologists practicing in Saudi Arabia gathered to update the 2014 Saudi guidelines for threatened and recurrent miscarriage management. In preparation, a literature review was conducted to explore the role of oral, vaginal, and injectable progestogens: this was used as a basis to develop position statements to guide and standardize practice across Saudi Arabia.

Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review

“…A total of 6065 records from the planned searches of databases (n = 5536), guideline repositories (n = 395) and websites of professional bodies and organizations (n = 134) were retrieved; the PRISMA flow chart is presented in After removing duplicates, the titles and abstracts of 4108 records were screened and, subsequently, 170 full texts were assessed. Thirty-two CPG were included in the final synthesis ( Group, 2017;Toth et al, 2018;Arab et al, 2019;Northern Ireland Public Health Agency, 2020), two (6%) focused on early pregnancy loss (American College of Obstetrics and Gynaecology [ACOG], 2018;Queensland Clinical Guidelines, 2018) and two (6%) on pregnancy loss, perinatal death, or both (HSE, 2016;Huchon et al, 2016). The remaining 21 (66%) CPG were broader in focus: uterine and/or genital anomalies (American Association of Gynecologic Laparoscopists [AAGL], 2012;Grimbizis et al, 2016;Practice Committee of the ASRM, 2016;, infertility (Practice Committee of the ASRM, 2015; Agarwal et al, 2017;Wall et al, 2020), thyroid disease during pregnancy and the postpartum (De Groot et al, 2012;Alexander et al, 2017) and more generally (Garber et al, 2012), genetic testing and/or prenatal diagnosis (Armour et al, 2018; Practice Committees of the ASRM and the Society for Assisted Reproductive Technology, 2018;Wilson, 2018;ESHRE Preimplantation Genetic Testing [PGT] Consortium Steering Committee et al, 2020), venous thromboembolism, and thrombophilia and/or antiphospholipid syndrome (Bates et al, 2012;Keeling et al, 2012;Hickey et al, 2013 or other, nine referred to three or more losses (53%), seven referred to two or more losses (41%) and one referred to two consecutive spontaneous losses or three or more spontaneous losses (6%).…”

“…Two recommendations from one CPG related to 'haematology' and stated that full blood count and electrolytes and liver function tests should be standard investigations (Queensland Clinical Guidelines, 2018). Two recommendations from two CPG related to 'unexplained recurrent miscarriage' and how this diagnosis can be made when investigations have been conducted, and no cause of recurrent miscarriage found (Toth et al, 2018;Arab et al, 2019).…”

“…Poor ( 7) Good ( 67) Good ( 67) YWM Saudi guidelines for threatened and recurrent miscarriage management; the role of progestogens in threatened and idiopathic recurrent miscarriage Arab, 2019 Average ( 50)…”

Clinical Use of Progestins and Their Mechanisms of Action: Present and Future (Review)

“…Successfully progressing pregnancy is accompanied by suppressed activity of type 1 T-helpers (Th1) and increased Th2 activity. For instance, increased levels of Th1-cytokines, IL-2, and interferon-γ and decreased levels of Th2-cytokines and IL-10 were observed in women with recurrent spontaneous miscarriage [ 84 ].…”

Comparison of Various Progesterone Drugs in Reducing Miscarriages

“…1 Results of many studies suggest that reduction in the secretion of progesterone can be the causative factor for recurrent miscarrgies. [2][3][4] Progestogen belongs to the group of drugs, called progestin. Progestins are synthetic form of naturally occurring hormone progesterone.…”