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Oral progestogen increases live birth rate among women with threatened miscarriage
Question clinique
Does progestogen treatment increase live births among women with threatened miscarriage?
L’Essentiel
This meta-analysis of 10 trials of progestogen among women with vaginal bleeding before 24 weeks' gestation showed that oral, but not vaginal, administration was effective to increase the rate of live births and reduce miscarriages. Since the number of trials of oral progestogen was small (n = 4; 520 participants), a larger trial of oral progestogen is needed. 1a-
Référence
Plan de l'etude: Meta-analysis (other)
Financement: Government
Cadre: Various (meta-analysis)
Sommaire
This study is a meta-analysis of progestogen as treatment to increase the live birth rate among women with threatened abortion (defined as any vaginal bleeding before 24 weeks' gestation). The authors identified 10 studies (N = 5056 participants) that met their inclusion criteria of being a randomized, quasi-randomized, or cluster-randomized controlled trial with outcomes of interest. All studies used a progestogen as treatment compared with placebo or no treatment. Six trials (n = 4790 participants) reported live birth rates: 72.9% with progestogen and 69.7% without progestogen, which was statistically significant, but marginally clinically significant. However, a subgroup analysis based on the route of administration showed that only oral progestogen administration was statistically significant (4 studies with 520 participants; relative risk [RR] 1.17; 95% CI 1.04 - 1.31; number needed to treat [NNT] = 10; 5 - 60); vaginal administration was not statistically significant. The progestogen most often used orally was dydrogesterone. Miscarriage rates were available for all 10 studies and showed a similar pattern, with only the oral progestogen associated with a statistically significant reduction (RR 0.58; 0.42 - 0.80; NNT 10; 6 - 23). Other secondary analyses included preterm birth, congenital abnormalities, and low birthweight, none of which differed between groups
Reviewer
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH
Commentaires
progesterone
I don't do obstetrics any more, but it is good to know as this might come up in a conversation with a patient.
progesterone for threatened miscarriage
I would argue that a 3% absolute risk reduction of loss of an otherwise healthy baby is clinically significant if it holds up. It would be plenty good enough for cancer care. I have a few mothers in my practice who would swear that progesterone is the reason that their children were live births. They both has recurrent pregnancy loss. I recall that when some moms missed more than a couple doses of progesterone, she would start cramping (the ever-popular N<10 study). We tried it because the moms were at wit's end, and it seemed to be a benefit to some. I suspect that this analysis will spur more study to focus on which subgroup(s) are being helped.
statistics is not medicine-
Need something other than statistics drug company sponsored studies to guide doctors
How about putting weight on science ?
Progesterone: The Saga Continues
Every few years progesterone gets revived and then it is proven ineffective then it is resuscitated. I cant keep track.