Efficacy of oral versus vaginal progestogens for early pregnancy maintenance in women with recurrent miscarriages: a randomized controlled trial

Abstract

OBJECTIVE: To compare the effectiveness of oral and vaginal progestogens in the maintenance of early pregnancy in women with recurrent miscarriages. METHODS: This randomized controlled trial was conducted at Lady Reading Hospital, Peshawar, Pakistan, from April to September 2021. Pregnant women aged 16–40 years with a history of at least three recurrent miscarriages presenting at or before 7 weeks of gestation were enrolled. A total of 108 patients were randomly assigned to two groups: Group A received oral progestogens (10 mg twice daily), and Group B received vaginal progestogens (200 mg twice daily). Treatment lasted for 12 weeks, with successful outcomes defined as no vaginal bleeding and pregnancy continuing beyond 12 weeks. Data analysis was conducted using SPSS-20 software. RESULTS: The mean age of patients was 29 ± 3.88 years in Group A and 27 ± 3.12 years in Group B. Oral progestogens (Group A) were effective in 48 (88.9%) patients, whereas vaginal progestogens (Group B) were effective in 36 (66.7%) patients (p=0.03). Oral progestogens showed significantly greater efficacy compared to vaginal progestogens in individuals aged 20-30 years (p=0.04) and those with fewer than four previous miscarriages (p=0.03). However, there was no significant difference in efficacy between the two groups for participants aged 31-40 years or those with 4 or more previous miscarriages. CONCLUSION: Oral progestogens are more effective than vaginal progestogens in preventing recurrent miscarriages, especially in participants aged 20–30 years and with fewer than 4 previous miscarriages. More research needed to validate and explore underlying mechanisms.

Keywords

• progestins
• fetal viability
• pregnancy
• parity
• abortion, habitual
• abortion, spontaneous
• recurrent miscarriages