Tuesday, April 18, 2017

Synthetic progestogens, but not natural progesterone, lowers miscarriage risk among women with unexplained RPL: Systematic review and meta-analysis.


Courtesy: Makena
Supplementation with progesterone reduces the risk of early pregnancy loss in women with unexplained earlier recurrent losses according to a Systematic review and meta-analysis published in Journal of Fertility and Sterility.

Women taking progestogens have a 28% lower risk of miscarriage (RR 0.72; 95% CI 0.53-0.97).  and 7% higher chances of live births as compared to women who did not receive any supplementation. (RR 1.07, 95% CI 1.02–1.15).

The Meta-analysis included 10 trials comprising a total of 1,586 women with history of recurrent miscarriage.

Two RCTs used natural progesterone while the rest 8 used progestins like medroxyprogesterone, cyclopentylenol ether of progesterone, dydrogesterone, or 17-hydroxyprogesterone caproate.

Pooled data did not show statically significant difference for secondary outcome of the studies like preterm births, fetal genital malformations and neonatal mortality.

Interestingly, vaginal progesterone and natural progesterone did not much effect the miscarriage rate while oral, intramuscular and synthetic form significantly lowered the miscarriage rate.

Intramuscular 17-alpha hydroxyprogesterone caproate weekly and oral dydrogesterone were both associated with significant reduction in miscarriage risk.

The authors conclude that because of limitations RCTs included in this meta-analysis, a recommendation regarding type and route of progesterone administrations are not possible to make.
Till we have more data from head to head analysis about route and type of progesterone, synthetic progestogens supplementation should be started in women with RPL as soon as pregnancy is confirmed.

Recurrent pregnancy loss (RPL) occurs in 5% of women. Many hematological, anatomic, hormonal, immune and genetic defect have been attributed in its causation but in most patients extensive evaluation is not able to pinpoint a cause.  



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