Evaluating the clinical efficacy and safety of progestogens in the management of threatened and recurrent miscarriage in early pregnancy- A review of the literature
Journal Title: Indian Journal of Obstetrics and Gynecology Research - Year 2016, Vol 3, Issue 2
Abstract
Background Progestogens have been considered as a viable therapeutic option for the treatment of miscarriage for more than half a century. Aim: The aim of the present review is to provide a comprehensive view of the literature regarding the clinical efficacy and safety effects of progestogens for preventing recurrent miscarriages and managing threatened miscarriage during early pregnancy. Methods: A literature search was performed using electronic databases like Pubmed/ Medline to identify from 1953 to 2015. The search yielded around 27 original studies and review articles. Results: Dydrogesterone (oral) and various micronized progesterone (MCP) given orally, vaginally and intramuscularly are the most commonly used progestogens for the treatment of recurrent and threatened miscarriages. Pharmacokinetic profile of dydrogesterone exhibits better bioavailability, receptor affinity, quick onset of action and a better half-life imparting long and stable effect. Dydrogesterone exhibits 47% and 29% statistically significant reduction in odds ratio of threatened and recurrent miscarriage when compared to standard of care. While, literature supports use of MCP (vaginal), recent findings suggest no statistically significant difference in live birth rate when compared to placebo (65.8% vs. 63.3%). MCP (vaginal) is associated with vaginal discharge and irritation whereas dydrogesterone (oral) avoids vaginal discharge and no birth defects have been associated with its use. Conclusion: Treatment with dydrogesterone and other progestogens in general suggest dydrogesterone has number of advantages over other progestogens in terms of pharmacokinetic parameter clinical efficacy and safety profile. However, further studies are warranted to establish and promote the role of these progestogens in management of threatened and recurrent miscarriage.
Authors and Affiliations
Manish R Pandya, P. Gopeenathan, P. M. Gopinath, S. K. Das, Meenakshi Sauhta, Veena Shinde
Keywords
Related Articles
- EP ID EP241313
- DOI -
- Views 92
- Downloads 0
A rare case of gangrenous hydrosalpinx
Adnexal torsion constitutes approximately 3% of Gynaecological emergencies and is one of the causes of acute abdominal pain in a woman. Here we present a rare case of a gangrenous hydrosalpinx which presented with acute...
Role of Zinc in Male Infertility: Review of Literature
Infertility is a worldwide problem with male factor contributing equally to infertility as females. Zinc is one of essential trace elements required for normal physiology of male reproduction and plays important role in...
A clinical study of placenta previa in semi urban population
Background/ Objectives: To study predisposing factors, management options, maternal & fetal outcome of placenta previa. Methods: The present study was carried out on 30 diagnosed cases of placenta previa admitted in Padm...
Application of PALM-COEIN FIGO classification in diagnosis of abnormal uterine bleeding (AUB) patients
Objective The aim is to categorize women with AUB as per the PALMCOEIN classification system as this is a step towards cause based diagnosis and focused management of patients The acronym PALMCOEIN comes from arranging 9...
Comparison of 60mg and 40mg doses of hyoscine butylbromide on labor outcomes at Moi teaching and referral hospital, Eldoret, Kenya
Introduction Effects of 40mg of Hyoscine butylbromide HBB in reducing duration of active phase of labor are well documented However effects of 60mg have not been well studied despite the fact that it is often usedObjecti...