Progestogen for treating threatened miscarriage

Abstract

BackgroundMiscarriage is a common complication encountered during pregnancy. It is defined as spontaneous pregnancy loss before 20 weeks' gestation. Progesterone's physiological role is to prepare the uterus for the implantation of the embryo, enhance uterine quiescence and suppress uterine contractions, hence, it may play a role in preventing rejection of the embryo. 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. This update of the Cochrane Review first published in 2007, and previously updated in 2011, investigates the evidence base for this practice. ObjectivesTo determine the efficacy and the safety of progestogens in the treatment of threatened miscarriage. Search methodsWe searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (8 August 2017) and reference lists of retrieved trials. Selection criteriaRandomised, quasi-randomised or cluster-randomised controlled trials, that compared progestogen with placebo, no treatment or any other treatment for the treatment of threatened miscarriage in women carrying singleton pregnancy. Data collection and analysisAt least two review authors assessed the trials for inclusion in the review, assessed trial quality and extracted the data and graded the body of evidence. Main resultsWe included seven trials (involving 696 participants) in this update of the review. The included trials were conducted in different countries, covering the full spectrum of the World Bank's economic classification, which enhances the applicability of evidence drawn from this review. Two trials were conducted in Germany and Italy which are high-income countries, while four trials were conducted in upper-middle income countries; two in Iran, one in Malaysia and the fourth in Turkey, and the seventh trial was conducted in Jordan, which is a lower-middle income country. In six trials all the participants met the inclusion criteria and in the seventh study, we included 1 Progestogen for treating threatened miscarriage (Review)

Oral versus Vaginal Micronized Progesterone for the treatment of threatened miscarriage

“…The literature also reports some findings were inconclusive data about the benefits of progestogens was found in the treatment of threatened miscarriage. 19 - 21 More trials with sound methodologies, randomized in nature, involving large sample size, multiple centers, and also having focus on delivery outcomes will further enlighten us about the aspects of progesterone in the treatment of threatened miscarriage.…”

Oral versus Vaginal Micronized Progesterone for the treatment of threatened miscarriage

“…The literature also reports some findings were inconclusive data about the benefits of progestogens was found in the treatment of threatened miscarriage. 19 - 21 More trials with sound methodologies, randomized in nature, involving large sample size, multiple centers, and also having focus on delivery outcomes will further enlighten us about the aspects of progesterone in the treatment of threatened miscarriage.…”

The pregnancy hormones human chorionic gonadotropin and progesterone induce human embryonic stem cell proliferation and differentiation into neuroectodermal rosettes

“…Our data suggest that trophoblastic hCG production adjacent to the embryoblast could be required, not only for trophoblast steroidogenesis and attachment of the blastocyst to the uterine wall [72], but also for signaling normal proliferation and differentiation of the embryoblast. hCG-induced P 4 synthesis therefore has, in addition to its role in uterine decidualization for the implantation and maintenance of pregnancy, an obligatory role before the formation of neural precursor cells (blastulation), as well as an inductive role in the directed differentiation and specification of the first neuronal cell types (organogenesis; Figure 4) and the formation of the neural tube.…”

Oral versus Vaginal Micronized Progesterone for the treatment of threatened miscarriage

“…The literature also reports some findings were inconclusive data about the benefits of progestogens was found in the treatment of threatened miscarriage. 19 - 21 More trials with sound methodologies, randomized in nature, involving large sample size, multiple centers, and also having focus on delivery outcomes will further enlighten us about the aspects of progesterone in the treatment of threatened miscarriage.…”

The pregnancy hormones human chorionic gonadotropin and progesterone induce human embryonic stem cell proliferation and differentiation into neuroectodermal rosettes

“…Our data suggest that trophoblastic hCG production adjacent to the embryoblast could be required, not only for trophoblast steroidogenesis and attachment of the blastocyst to the uterine wall [72], but also for signaling normal proliferation and differentiation of the embryoblast. hCG-induced P 4 synthesis therefore has, in addition to its role in uterine decidualization for the implantation and maintenance of pregnancy, an obligatory role before the formation of neural precursor cells (blastulation), as well as an inductive role in the directed differentiation and specification of the first neuronal cell types (organogenesis; Figure 4) and the formation of the neural tube.…”

Oral versus Vaginal Micronized Progesterone for the treatment of threatened miscarriage

“…The literature also reports some findings were inconclusive data about the benefits of progestogens was found in the treatment of threatened miscarriage. 19 - 21 More trials with sound methodologies, randomized in nature, involving large sample size, multiple centers, and also having focus on delivery outcomes will further enlighten us about the aspects of progesterone in the treatment of threatened miscarriage.…”

The pregnancy hormones human chorionic gonadotropin and progesterone induce human embryonic stem cell proliferation and differentiation into neuroectodermal rosettes

“…Our data suggest that trophoblastic hCG production adjacent to the embryoblast could be required, not only for trophoblast steroidogenesis and attachment of the blastocyst to the uterine wall [72], but also for signaling normal proliferation and differentiation of the embryoblast. hCG-induced P 4 synthesis therefore has, in addition to its role in uterine decidualization for the implantation and maintenance of pregnancy, an obligatory role before the formation of neural precursor cells (blastulation), as well as an inductive role in the directed differentiation and specification of the first neuronal cell types (organogenesis; Figure 4) and the formation of the neural tube.…”