Progestogens in the management of miscarriage and preterm birth

Miscarriage affects up to 20% of pregnant women, resulting in substantial psychological repercussions in addition to inherent problems from bleeding and infection. Preterm births constitute about 7-12% of all births but are over represented in terms of perinatal morbidity and mortality. Despite existing trials examining the use of progestogens in both these conditions, there is a dearth of guidelines for the practicing clinician. A systematic review of the literature was performed by an expert panel formed by the Obstetrical & Gynaecological Society of Malaysia from the inception of the databases searched up to February 2020, without language restrictions. The level of evidence and recommendations was determined by the panel and peer-reviewed by local and international experts. The use of progestogens is recommended in women with threatened miscarriages who have experienced previous miscarriage as luteal phase support in women undergoing assisted reproduction and in women with short cervix of <25mm in the midtrimester. In addition, it can be considered in women with recurrent miscarriage, where no other cause is identified. This article reviews the existing evidence including the guideline above and is intended to aid primary care doctors and obstetricians in their prescribing practices when managing these common conditions.