Abstract
Objectives:This study was planned with an aim to find out the effectiveness of oral versus vaginal micronized progesterone for the treatment of threatened miscarriage.Methods:This randomized controlled trial was conducted at The Department of Obstetrics and Gynaecology, Nishtar Hospital Multan, from August 2019 to January 2020. A total of 136 pregnant women, aged 18 to 45 years having vaginal bleeding were included and divided into two groups (68 women in each group). Participants in the Group-A were given oral micronized progesterone as 200mg twice a day while Group-B participants were given vaginal progesterone suppository 400mg once a day. All women were followed up until 20th week of their pregnancy. Outcome was labeled as prevention of miscarriage if woman had no bleeding per vagina and pregnancy went beyond 20th weeks of gestation.Results:In a total of 136 women enrolled, mean age was noted to be 30.85+3.34 years. Overall, mean gestational age was noted to be 9.3+2.7 weeks. A total of 98 women (49 in each group) completed the follow up and were included in the final analysis regarding outcome. Among Groups-A, 45 (91.8) had prevention of miscarriage while 4 (9.2%) had miscarriage in comparison to 36 (73.5%) in Group-B had prevention of miscarriage whereas 13 (26.5%) had miscarriage and this difference was statistically significant in between the both study groups as women in Group-A had significantly better outcome in terms of prevention of miscarriage. (P value = 0.0164).Conclusion:The use of oral micronized progesterone was found to be significantly more effective than vaginal progesterone in women with threatened miscarriage.
Highlights
Miscarriage is described as loss of spontaneous pregnancy prior 20 weeks of gestation.[1]
Recent decades have seen lots of advancements for prevention and management of women who are at risk of clinical miscarriage at the early phase of their pregnancy but still it is a matter of real concern for the healthcare professionals
Progesterone is commonly termed as “pregnancy hormone”, has a more improvised role during early pregnancy as it is responsible for the preparation of the endometrium for the implantation as well as maintenance of gestational sac in the uterus.[7]
Summary
Miscarriage is described as loss of spontaneous pregnancy prior 20 weeks of gestation.[1]. Threatened miscarriage, described as vaginal bleeding in the presence or absence of abdominal cramps, is considered the commonest complication of early pregnancy and estimated. Pak J Med Sci May - June 2021 Vol 37 No 3 www.pjms.org.pk 628 to occur in about 20% of pregnancies prior to 20th week of gestation.[3] Well known risk factors of threatened miscarriage are high maternal age, high body mass index prior to pregnancy and low serum progesterone levels.[4,5,6]. Progesterone is commonly termed as “pregnancy hormone”, has a more improvised role during early pregnancy as it is responsible for the preparation of the endometrium for the implantation as well as maintenance of gestational sac in the uterus.[7] On the other hand, low levels of serum progesterone have been seen to cause threatened miscarriage. Researchers have noted progesterone to help in promoting muscle protein synthesis in utero, aid sensitivity of prostaglandin and estrogen as well as playing a major role in preventing early contraction of the myometrium.[8]
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