Arri Coomarasamy, Ewa G Truchanowicz, Raj Rai
Coomarasamy A, Truchanowicz E G, Rai R.
Does first trimester progesterone prophylaxis increase the live birth rate in women with unexplained recurrent miscarriages?
BMJ 2011; 342 :d1914
doi:10.1136/bmj.d1914
First trimester progesterone prophylaxis in women with unexplained recurrent miscarriages
Re. Coomarasamy A, Truchanowicz EG, Rai R. Does first trimester
progesterone prophylaxis increase the live birth rate in women with
unexplained recurrent miscarriages? BMJ 2011; 342:d1914
Madam,
Regarding the role of progesterone in unexplained recurrent
miscarriages, Coomarasamy et al1 state that currently most clinicians do
not use progesterone for recurrent miscarriages due to the lack of
supportive evidence.
We conducted a retrospective cohort study (unpublished data) to
investigate progesterone supplementation for recurrent miscarriages. This
was not a controlled trial but we compared our data with Knudsen's
historical data2.
Early pregnancy surveillance was offered to all recurrent miscarriage
patients measuring initial and after 48 hours further repeat progesterone
levels. Women were divided in three groups; progesterone supplementation
was offered to those whose initial progesterone was less than 40 IU/L or
their 48 hour repeat progesterone did not rise by an increment of 15%.
Those with rising progesterone were not treated.
We have examined 209 consecutive cycles over 10 years for pregnancy
outcome. The miscarriage rate was 36 out of 102 cycles, 35% (95%CI 26-
45%), and 22 out of 71 cycles, 31% (95%CI 21-43%) for three and four
previous miscarriages respectively. Knudsen et al2 showed that subsequent
miscarriage rate without progesterone supplementation was 45% (95%CI 40-
50%) and 54% (95% CI 44-64%) in patients with previous three and four
miscarriages respectively. Comparison of the data sets show a reduction in
miscarriage rates when supplemented with progesterone (our data) compared
with the untreated group (Knudsen's historical data).
We look forward to see the results of the PROMISE Trail which we
expect will provide convincing evidence for the role of progesterone for
the management of recurrent miscarriage.
Munawar Hussain 1, 4, Samawal El Hakim 2, David Cahill 3.
1 Subspecialty Training Fellow in Reproductive Medicine &
Surgery. St. Michael's Hospital Bristol.UK. BS2 8EG.
2 Consultant Reproductive Medicine & Surgery Dr Sulaiman Al-Habib
Hospital Qassim Saudi Arabia.
3Reader in Reproductive Medicine, Head of the Academic Unit of
Obstetrics & Gynaecology School of Clinical Sciences, University of
Bristol
Level D, St Michael's Hospital Bristol.
4 Corresponding address. E-mail: dr_72hussain@yahoo.com
References.
1. Coomarasamy A, Truchanowicz EG, Rai R. Does first trimester
progesterone prophylaxis increase the live birth rate in women with
unexplained recurrent miscarriages? BMJ 2011; 342:d1914.
2. Knudsen UB, Hansen V, Juul S, Secher NJ. Prognosis of a new pregnancy
following previous spontaneous abortions. Eur J Obstet Gynecol Reprod
Biol. 1991; 39(1):31-36.
Competing interests: No competing interests