Progestogen for treating threatened miscarriage

Miscarriage occurs in about 15% to 20% of pregnancies. Threatened miscarriage is when a mother might be losing her baby at less than 20 weeks' gestation. The signs are vaginal bleeding, with or without abdominal pain, while the cervix is closed. The use of ultrasound scans in the management of bleeding in early pregnancy has improved the diagnosis and management, as attempts to maintain a pregnancy are likely to be effective only if the fetus is viable and has no chromosomal abnormalities. Once the cervix begins to open, pregnancy loss is inevitable. The loss can cause emotional problems including depression, sleep disturbances, and anger. Women who continue with their pregnancy after threatened miscarriage were found to have increased risk of antepartum haemorrhage, pre-labour rupture of the membranes, preterm delivery, and intrauterine growth restriction. Progestogen is an essential hormone both for establishing and maintaining pregnancy. It is therefore a possible treatment for threatened miscarriage. The review of trials located four randomised studies involving 421 women that compared the use of progestogens in the treatment of threatened miscarriage with either placebo or no treatment. The limited evidence suggests that the use of a progestogen does reduce the rate of spontaneous miscarriage. Two trials reported that treatment with progestogens did not increase the occurrence of congenital abnormalities in the newborns and the women did not have any significant difference in incidence of pregnancy-induced hypertension nor antepartum haemorrhage. Further larger studies are warranted for firmer conclusions.