Efficacy of progesterone on threatened miscarriage: an updated meta-analysis of randomized trials
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REVIEW
Efficacy of progesterone on threatened miscarriage: an updated meta‑analysis of randomized trials Yuying Yan1 · Zeping Chen1 · Ying Yang1 · Xinkuo Zheng1 · Meijuan Zou2 · Gang Cheng2 · Zhenting Yuan3 Received: 29 August 2019 / Accepted: 18 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The efficacy of progesterone supplementation in the treatment of threatened miscarriage is controversial. This meta-analysis was to evaluate the correlation between progesterone and improving pregnancy outcomes in women with threatened miscarriage. Methods We searched PubMed, EMBASE, and the Cochrane Library for relevant randomized controlled trials (RCTs) to demonstrate the efficacy of progesterone on the threatened miscarriage pregnancy. The outcomes were miscarriage, preterm birth, and live birth. Results Nine RCTs comparing 4907 patients were included in this study. Compared with placebo or no treatment, progesterone supplementation had a relationship with a reduction in the rate of miscarriage [RR 0.70 95% Cl (0.52, 0.94)]. There was no significant difference between progesterone supplementation and placebo or no treatment in preterm birth [RR 0.87 95% Cl (0.52, 1.47) and live birth (RR 1.02 95% Cl (0.98, 1.07)]. Conclusion Progesterone supplementation did not significantly improve the incidence of preterm and live birth, so progesterone treatment of threatened miscarriage may be unhelpful. Keywords Progesterone · Threatened miscarriage · Rcts · Meta-analysis
* Gang Cheng [email protected] * Zhenting Yuan [email protected] Yuying Yan [email protected] Zeping Chen [email protected] Ying Yang [email protected] Xinkuo Zheng [email protected] Meijuan Zou [email protected] 1
Department of Life Sciences and Biopharmaceutics, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, Liaoning, China
2
Department of Pharmaceutical Sciences, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, Liaoning, China
3
No. 230 Hospital of P.L.A., 19 Shijing Street, Dandong 118000, Liaoning, China
Introduction Threatened miscarriage refers to a small amount of vaginal bleeding before the 20th week of pregnancy, with or without abdominal pain. The cervix is not open. The membrane is not broken, and the fetus is survived in the uterine cavity [1]. It is suggested that low progesterone level is the cause of miscarriage, so progesterone supplementation may prevent miscarriage. However, the efficacy of progesterone in the treatment of threatened miscarriage has always been clinically controversial [2]. According to the previous meta-analysis and RCT trials, the evidentiary support for the effectiveness of this treatment is also uncertain. And the previous meta-analysis has the disadvantage that the sample size is small and the conclusion is unreliable. A large RCT trial [3] was recently published, which denied the effectiveness of progesterone and was inconsistent with the latest meta-analysis. Therefore, the purpose of this updated meta-
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