Dharmavijaya M. N.1 , Shilpa Vijayakumar2
BACKGROUND There is a great probability of foetal demise and abnormal outcomes in the first trimester of a recognized pregnancy. 20% pregnancies have first trimester complications out of which the most common is miscarriage. Threatened miscarriage is a risk factor occurring in about 20-25% of confirmed pregnancies which may progress or resolve. Inadequate progesterone secretion has been implicated in the aetiology of miscarriage. The current study was undertaken to study the efficacy of progesterone in the management of first trimester threatened miscarriage. METHODS A prospective randomized clinical trial was conducted in a rural tertiary health care center from Jan 2018 to March 2019. A total of 100 pregnant women who had a viable pregnancy who were admitted for threatened abortion in the first trimester, fulfilling the inclusion and exclusion criteria, were selected after taking an informed consent. Patients were further divided into 2 groups of 50 patients each. Group A was treated with progesterone and Group B was given supportive treatment without progesterone. They were observed for relief of symptoms, and progression to second trimester or spontaneous miscarriage. RESULTS Parameters like age, gravidity, period of gestation and body mass index at the time of admission did not have a significant difference between the two groups. Symptoms like vaginal bleed and abdominal pain reduced in 54% and 52% of patients who received progesterone respectively; while, vaginal bleed and abdominal pain reduced only in 40% and 38% of patients who received only symptomatic treatment respectively. 54% of patients who received progesterone and 38% of patients who received only symptomatic treatment could continue the pregnancy further. CONCLUSIONS Pregnant women with first trimester threatened miscarriage have a great risk for spontaneous loss of pregnancy. Progesterone may help clinically, but has no statistically significant improvement in the outcome of pregnancy. Further trials are required utilizing other forms and dosages of progesterone and other routes of administration.
