Volume 127, Issue 9 p. 1055-1063
Systematic review

Effect of progestogen for women with threatened miscarriage: a systematic review and meta-analysis

L Li

L Li

West China Hospital, Sichuan University, Chengdu, Sichuan, China

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Y Zhang

Y Zhang

West China Hospital, Sichuan University, Chengdu, Sichuan, China

Clinical Research Centre, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China

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H Tan

H Tan

West China Hospital, Sichuan University, Chengdu, Sichuan, China

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Y Bai

Y Bai

West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China

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F Fang

Corresponding Author

F Fang

West China Hospital, Sichuan University, Chengdu, Sichuan, China

Correspondence: Fang Fang, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China. Email: [email protected]

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A Faramand

A Faramand

University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA

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W Chong

W Chong

Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

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Y Hai

Y Hai

Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA

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First published: 23 April 2020
Citations: 16
Drs Li and Zhang contributed equally to this work as first authors.
Systematic review registration: PROSPERO CRD42019136611.

Abstract

Background

Threatened miscarriage is a common complication of pregnancy. Results of randomised controlled trials on the efficacy of progestogen in the treatment of threatened miscarriage remain inconsistent.

Objective

To investigate whether the use of progestogen is associated with improved event rate of live birth and other benefits in women with threatened miscarriage.

Search strategy

Ovid MEDLINE, Ovid Embase and Cochrane CENTRAL Register of Controlled Trials from their inception until 8 July 2019.

Selection criteria

Randomised controlled trials comparing progestogen with a placebo or no treatment for pregnancy outcomes in women with threatened miscarriage.

Data collection and analysis

Two authors independently conducted data extraction and assessed study quality. We calculated risk ratios (RR) and 95% confidence intervals using the Mantel–Haenszel approach for dichotomous outcomes.

Main results

Ten trials with a total of 5056 participants were eligible for analysis. The use of progesterone increased the incidence of live birth (RR 1.07, 95% CI 1.00–1.15; P = 0.04; I2 = 18%), with benefit only seen with the use of oral progestogen (RR 1.17, 95% CI 1.04–1.31; P = 0.008; I2 = 0%) and not with vaginal progesterone (RR 1.04, 95% CI 1.00–1.08; P = 0.07; I2 = 0%). Similarly, progestogen reduced the risk of miscarriage (RR 0.73, 95% CI 0.59–0.92), with benefit only seen with oral progestogen and not with vaginal progesterone.

Conclusion

Progestogens may have benefits on live birth rate and miscarriage rate for women with threatened miscarriage. These benefits appear to be confined to the use of oral progestogen, and no statistically significant improvements were seen with vaginal progesterone.

Tweetable abstract

A meta-analysis of 10 trials found that progestogens increased live birth rates and reduced miscarriage rates for women with threatened miscarriage.