Progestogen for treating threatened miscarriage

Abstract

of findings for the main comparison. Progesterone compared to placebo or no treatment for treating threatened miscarriage Progesterone compared to placebo or no treatment for treating threatened miscarriage Patient or population: women with threatened miscarriage Setting: two in high-income countries (Germany and Italy), four in upper-middle income countries (two in Iran, one in Malaysia and one in Turkey) and one in lower-income country (Jordan). All in hospitals (university or women's) or medical centres Intervention: progesterone Comparison: placebo or no treatment Anticipated absolute effects * (95% CI) Outcomes Risk with placebo or no treatment Risk with progesterone Relative effect (95% CI) № of participants (trials) Certainty of the evidence (GRADE) Comments Study population Miscarriage 242 per 1000 138 per 1000 (102 to 189) RR 0.64 (0.47 to 0.87) 696 (7 RCTs) ⊕⊕⊕⊝ Moderate 1 Study population Preterm birth 91 per 1000 84 per 1000 (49 to 142) RR 0.86 (0.52 to 1.44) 588 (5 RCTs) ⊕⊕⊝⊝ Low 1, 2 Study population Congential abnormalities 13 per 1000 9 per 1000 (1 to 62) RR 0.70 (0.10 to 4.82) 337 (2 RCTs) ⊕⊝⊝⊝ Very low 1, 2, 3 *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.

Routine Progesterone Supplementation in Threatened Abortion: Is It a Sound Practice?

“…Cochrane systematic review (2011) stated that treatment of threatened abortion with progestogens compared to placebo reduced the risk of abortion to 0.47% while no difference regarding preterm labour [6]. Similarly, Lee et al…”

“…They found that treatment of abortion with progestogens compared to placebo reduced the risk of abortion to 0.47% while no difference regarding preterm labour. They were uncertain about the relation of progestogen to congenital anomalies as the quality of evidence was low [6].…”

Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiology

“…The aim of this updated review is to study all available data to determine the efficacy and safety of administering prophylactic progesterone in an attempt to prevent pregnancy loss in the population of women with recurrent miscarriages. There is a separate Cochrane Review on the use of progestogens for treating women with threatened miscarriage (Wahabi 2018). This is an update of a review last published in 2013 (Haas 2013).…”

“…Thus, this updated Cochrane Review is in agreement with and includes more trials than prior published systematic reviews. A separate Cochrane Review has also been conducted on the use of progestogens for treating women with threatened miscarriage (Wahabi 2018), and this also suggests a benefit in terms of a reduction in miscarriage in those women treated with progestogens.…”

“…'Summary of findings ' table incorporated 6 July 2017 New citation required but conclusions have not changed Title amended and focus of review changed from treatment of all miscarriage to treatment of recurrent miscarriage. This was done to eliminate treatment for threatened miscarriage as that is covered in a separate Review (Wahabi 2018).…”