Can vaginal progesterone prevent miscarriage?

  • Am J Obstet Gynecol

  • von Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Micronized vaginal progesterone shows potential benefit in women with a history of miscarriage experiencing vaginal bleeding in the first trimester.

Why this matters

  • Withdrawal of progesterone, naturally (corpus luteum defect) or via antiprogesterone drugs (mifepristone), induces abortion.

Key results

  • Small but positive treatment effect in women with bleeding and history of prior miscarriage; dependent upon the number of miscarriages.
  • No benefit for women with bleeding but no history of miscarriage.
  • No evidence of increased risk for congenital anomalies or increased harm.
  • These authors recommend that women with a history of miscarriage and vaginal bleeding should be offered micronized vaginal progesterone (400 mg BID) from presentation until 16 weeks.

Study design

  • Review and expert commentary.
  • Evaluation of results from the PROMISE (PROgesterone in recurrent MIScarriagE) and PRISM (PRogesterone In Spontaneous Miscarriage) trials.
  • The PROMISE trial examined the use of micronized vaginal progesterone in women with unexplained recurrent miscarriage.
  • The PRISM trial examined the use of micronized vaginal progesterone in women with threatened miscarriage.
  • Funding: PROMISE and PRISM were funded by the National Institute for Health Research and Tommy’s charity support of the UK Miscarriage Research Network.

Limitations

  • Validation of results needed.