RHL Commentary by Felipe Santana
EVIDENCE SUMMARY
This review analysed data from 14 trials involving 1988 women with pregnancy of up to 20 in order to assess the efficacy and safety of progestogens as a preventative therapy against miscarriage. In most of the trials the participants were deemed to be at an increased risk of miscarriage based on: history of miscarriages; having been through a procedure that involves uterine manipulation; or threatened miscarriage. The type of progestogen preparation (synthetic or natural), route of administration (oral, intramuscular and vaginally), and the dosage and timing of administration varied across the trials.
Meta-analysis of the fourteen trials concluded that exogenous progestogen administration in the first 20 weeks of pregnancy does not reduce the risk of miscarriage in the first 20 weeks of pregnancy. However, when a sub-group analysis was carried out among three small trials, that included women with three or more consecutive miscarriages, a statistically significant reduction in miscarriage was found (93 women, odds ratio [OR] 0.39; 95% confidence interval [CI] 0.17-0.91). Those three trials were small and had methodological weaknesses.
The review search strategy and methodology are satisfactory.
The full RHL commentary also includes sections on: Relevance
- Magnitude of the problem
- Applicability of results
- Implementation of the intervention
Research
References
This document should be cited as: Felipe Santana. Progestogens for preventing miscarriage: RHL commentary (last revised: 11 January 2006). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
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