Progestogens for preventing miscarriage: a network meta-analysis

Devall, Adam J.; Papadopoulou, Argyro; Podesek, Marcelina; Haas, David M.; Price, Malcolm J; Coomarasamy, Arri; Gallos, Ioannis D

doi:10.1002/14651858.cd013792.pub2

Cited by 41 publications

(45 citation statements)

References 89 publications

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“…Supplementation with different progestogens in early pregnancy has been attempted to rescue a pregnancy in women with early pregnancy bleeding to treat threatened miscarriage [ 26 ]. Oral dydrogesterone are used to treat threatened abortion which was further stated effective in recent study [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Prediction of miscarriage in first trimester by serum estradiol, progesterone and β-human chorionic gonadotropin within 9 weeks of gestation

Deng

Sun

et al. 2022

BMC Pregnancy Childbirth

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Purpose To predict miscarriage outcome within 12 weeks of gestational age by evaluating values of serum estradiol, progesterone and β-human chorionic gonadotropin (β-HCG) within 9 weeks of gestation. Methods One hundred sixty-five women with singleton pregnancies were retrospectively studied. Estradiol, progesterone and β-HCG levels were measured at 5–6 weeks of gestation and the measurements were repeated at 7–9 weeks. According to pregnancy outcome at 12 weeks of gestation, 71 cases were categorized into miscarriage group, and 94 cases into group of normal pregnancy. Each group was further divided into 5–6 and 7–9 weeks of gestation sub-group. Predictive values of estradiol, progesterone and β- HCG levels at 5–6 weeks and 7–9 weeks of gestation were analyzed with receiver operating characteristic (ROC) curves and logistic regression. Results Serum levels of estradiol at 7–9 weeks identified miscarriage with an area under the ROC curve (AUC) of 0.866 (95% CI 0. 793 ~ 0.938, P = 0.000), diagnostic cutoff value of 576 pg/ml, sensitivity of 0.804, and specificity of 0.829 respectively at the optimal threshold, according to Youden index. Progesterone levels at 7–9 weeks were with AUC of 0.766 (95% CI 0. 672 ~ 0.861, P = 0.000), cutoff value of 15.27 ng/ml, sensitivity of 0.921, and specificity of 0.558, respectively; Estradiol at 5–6 weeks were with AUC of 0.709 (95% CI 0. 616 ~ 0.801, P < 0.001), the diagnostic cutoff value of 320 pg/ml, sensitivity of 0.800, and specificity of 0.574, respectively. The performance of the dual markers of estradiol and progesterone analysis (AUC 0.871, CI 0.793–0.950), three-markers analysis (AUC 0.869, CI 0.759–0.980)were slightly better than the single marker at 7-9 weeks. β-HCG or progesterone provide additional utility of estradiol prediction at 5–6 weeks with AUC 0.770 (0.672–0.869) for β-HCG and estradiol, AUC0.768(CI 0.670–0.866) for β-HCG, estradiol and progesterone and AUC 0.739 (CI 0.651–0.827) for progesterone and estradiol. Conclusions Low serum levels such as dual of estradiol and progesterone or estradiol alone at 7–9 weeks, β-HCG or progesterone combing estradiol at 5–6 weeks of gestation can be used better to predict miscarriage in first trimester.

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Section: Discussionmentioning

confidence: 99%

Prediction of miscarriage in first trimester by serum estradiol, progesterone and β-human chorionic gonadotropin within 9 weeks of gestation

Deng

Sun

et al. 2022

BMC Pregnancy Childbirth

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“…Similarly, there have been conflicting reports on the effectiveness of progesterone in the treatment of TM. A recent Cochrane review concluded that the available evidence suggests that progestogens probably make little or no difference in the live birth rate in women with TM [27].…”

Section: Discussionmentioning

confidence: 99%

The Influence of Threatened Miscarriage on Pregnancy Outcomes: A Retrospective Cohort Study in a Nigerian Tertiary Hospital

Akpan¹,

Akpanika²,

Asibong³

et al. 2022

Cureus

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Background: Pregnancies complicated by threatened miscarriage (TM) may be associated with adverse pregnancy outcomes. The objective of this study was to compare the differences in pregnancy outcomes between the women who experienced TM and asymptomatic controls.Methods: This was a 10-year retrospective review. Case records of 117 women who were managed for TM from January 1, 2010, to December 31, 2019, were retrieved and studied. The control group was developed from an equal number of asymptomatic clients matched for age, parity, and BMI who were receiving antenatal care (ANC) during the same period. Data on demography, clinical and ultrasound findings, treatment, and pregnancy outcomes were retrieved and analyzed.Results: Spontaneous abortion rate of 13.7% was recorded among the study group compared with 3.4% in the control (P-value [p] = 0.005, odds ratio [OR]: 4.475; 95% confidence interval [

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“…Based on the combined data from the PROMISE and PRISM trials in women with RM, vaginal progesterone therapy may be offered up until the 16th week of gestation if bleeding due to impending miscarriage is diagnosed 126 . Based on data from the recent Cochrane meta-analysis, this recommendation can be expanded to include women with bleeding due to impending miscarriage and one or two prior spontaneous miscarriages 124 .…”

Section: Guidelinementioning

confidence: 99%

“…SSW angeboten werden, wenn eine Abortus-imminens-Blutung diagnostiziert wird 126 . Basierend auf den Daten der aktuellen Cochrane-Metaanalyse kann diese Empfehlung auch auf Frauen mit Abortus-imminens-Blutung und 1 oder 2 spontanen Fehlgeburten in der Anamnese ausgeweitet werden 124 .…”

Section: Leitlinieunclassified

Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/050, May 2022)

Tóth

Bohlmann²,

Hancke

et al. 2022

Geburtshilfe Frauenheilkd

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Purpose The aim of this guideline is to standardize the diagnosis and therapy of recurrent miscarriage (RM) using evidence from the recent literature. This is done by using consistent definitions, objective evaluations and standardized treatment protocols. Methods When this guideline was compiled, special consideration was given to previous recommendations in prior versions of this guideline and the recommendations of the European Society of Human Reproduction and Embryology, the Royal College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine, and a detailed individual search of the literature about the different topics was carried out. Recommendations Recommendations about the diagnostic and therapeutic procedures offered to couples with RM were developed based on the international literature. Special attention was paid to known risk factors such as chromosomal, anatomical, endocrinological, physiological coagulation, psychological, infectious and immune disorders. Recommendations were also developed for those cases where investigations are unable to find any abnormality (idiopathic RM).

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Progestogens for preventing miscarriage: a network meta-analysis

Abstract: Analysis 2.3. Comparison 2: Threatened miscarriage: Dydrogesterone versus placebo, Outcome 3: Preterm birth (defined as birth before 37 weeks of gestation

Cited by 41 publications

References 89 publications

Prediction of miscarriage in first trimester by serum estradiol, progesterone and β-human chorionic gonadotropin within 9 weeks of gestation

Prediction of miscarriage in first trimester by serum estradiol, progesterone and β-human chorionic gonadotropin within 9 weeks of gestation

The Influence of Threatened Miscarriage on Pregnancy Outcomes: A Retrospective Cohort Study in a Nigerian Tertiary Hospital

Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/050, May 2022)

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