Individual research recommendation details

Recommendation ID

NG126/03

Question

Effectiveness of progestogens in women with recurrent miscarriage: What is the clinical and cost effectiveness of progesterone for improving outcomes in women with unexplained recurrent miscarriage?

Any explanatory notes
(if applicable)

Why this is important?

Women with previous pregnancy losses have an increased risk of miscarriage in subsequent pregnancies. Progesterone is essential for maintaining a healthy pregnancy, and there is evidence that it is safe for both women and fetuses.

A recent randomised controlled trial assessed the effectiveness of micronised vaginal progesterone supplementation in women with 3 or more first-trimester losses and did not show a benefit with progesterone therapy use during the first trimester, concluding that there is not enough evidence to support its use in women with unexplained recurrent miscarriage. However, this trial was designed to look for a 10% difference in live birth outcomes in those who received progesterone versus those who did not receive it. A larger randomised controlled trial is needed to determine if there is a smaller difference (for example 2.5% to 5%) which would still lead to a meaningful increase in live births and reduce the trauma of a further miscarriage for a number of women.

Source guidance details

Comes from guidance

Ectopic pregnancy and miscarriage: diagnosis and initial management

Number

NG126

Date issued

April 2019

Other details