Efficacy Of Progesterone In Threatened Miscarriage:A Meta-analysis

Objective:To investigate whether treatment with progesterone would decrease the incidence of miscarriage in women who faced with threatened miscarriage.Intervention:Randomized,controlledtrial studies were identified by searching PubMed,Embase,Cochrane Library and web of science.The includedstudies were comparing progesteroneVS placebo or no treatmentin pregnancy who faced with threatened miscarriage.Pre-pregnancy preventive medication were not included,no strict of types of progesterone,languages and progesterone administration.Result:Eight randomized controlled trials including 845 women who faced with threatened miscarriage were analyzed.Pooled data from the 8 trials showed that pregnancy with threatened miscarriage were randomized to allocation to the progesterone group had a lower risk of miscarriage(RR=0.65,95%CI 0.47-0.90)compared with those who get placebo or no treatment.Dydrogesterone shows a lower risk of miscarriage(RR=0.43,95%CI 0.26-0.71)than natural progesterone(RR=0.67,95%CI 0.19-1.18).Oral managementwas demonstrated to have a lower risk of miscarriage(RR=0.60,95%CI 0.29-1.25)than vaginal administration(RR=0.56,95%CI 0.36-0.87).Conclusion:Our findings show that progesterone agents is effective in reduce the incidence of miscarriagesin threatened miscarriage.Dydrogesterone but not natural progesterone,was associated with a lower risk of miscarriage.Given the limitations of the studies included in our meta-analysis,it is difficult to recommend route and dose of progesterone therapy.Further head-to-head trials of gestational weeks and long-time follow up are required.