Recommendation ID

Are progesterone or progestogens effective in treating threatened miscarriage?

Any explanatory notes
(if applicable)

Approximately 20% of pregnancies miscarry in the first trimester and many women will experience some bleeding and/or pain in early pregnancy that does not cause miscarriage. In many countries, women with bleeding and/or pain will be treated with progesterone or progestogens to try and decrease the risk of miscarriage. The evidence for the effectiveness of this treatment has been inconclusive, but data from a meta-analysis of several small studies suggest that progestogens are better than placebo. However, there are theoretical risks to prescribing any treatment in pregnancy and for many practitioners this will be a major change in practice. The lack of strong evidence makes this a priority area for research.

A very large multicentre randomised controlled trial of women receiving treatment with either progesterone/progestogen or placebo should be conducted. The trial should be large enough to be sufficiently powered to detect differences in long-term outcomes. The population would be women with pain and bleeding and a spontaneous, confirmed, viable, singleton, intrauterine pregnancy between 6 and 12 weeks' gestation. Progesterone/progestogen or placebo would be administered from when bleeding starts until the end of the 13th week. Pregnancy proceeding beyond the end of the first trimester might be the primary outcome. Live birth should also be measured, as well as pregnancy outcome, gestation at birth and presence of congenital abnormalities.

Source guidance details

Comes from guidance
Ectopic pregnancy and miscarriage: diagnosis and initial management
Date issued
April 2019

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 17/04/2019