A Critical Evaluation of Micronized Vaginal Progesterone to Prevent Miscarriage
Introduction
Recurrent miscarriage affects ~1% of couples who attempt to have a child, while Miscarriage affects 1 in 5 pregnancies.
Aim & Study Design
Two large, high-quality, multicenter placebo-controlled trials evaluated effects of first-trimester use of micronized vaginal progesterone (MVP) in women at risk of a miscarriage:
- PROMISE [PROgesterone in recurrent MIScarriagE] trial in women with unexplained recurrent miscarriages, and
- PRISM [PRogesterone in Spontaneous Miscarriage] trial in women with early pregnancy bleeding
Results
PROMISE trial showed trend for greater benefit with increasing number of previous miscarriages.
PRISM trial demonstrated greater benefit for the subgroup of women with >3 previous miscarriages and current pregnancy bleeding.
(a) Live birth after 34 weeks of gestation; (b) Live birth after 24 weeks of gestation
Conclusion
Women who have had a past miscarriage and who experience bleeding in early pregnancy may benefit with MVP 400 mg twice daily started at the time of presentation with vaginal bleeding and continued to 16 completed weeks of gestation.
Am J Obstet Gynecol. 2020 Aug; 223(2): 167–176.
