PROGESTERONE IN RECURRENT & THREATENED MISCARRIAGE
Watch an excerpt presented by renowned expert Dr. Narendra Malhotra (President FOGSI 2008) from the replay of an insightful webinar "Bursting the Myths & Realities of RPL".
Key Takeaways:
• Miscarriage occurs in 30% of pregnancies – 30% prior to implantation – 30% following implantation, but before the missed period & 10% are clinical miscarriages.
• Work up for early RPL & treatment plan – progesterone is used in all the cases.
• Women who have not had at least one liveborn infant with 2 or more fetal losses – recurrence risk for next pregnancy is 40-45%.
• Start progesterone before pregnancy.
• The debate is whether micronized progesterone, intramuscular or oral dydrogesterone - which progesterone to use.
• Oral is preferred for patient convenience & compliance. Choose between sustained release oral micronized or oral dydrogesterone.
• Dydrogesterone is superior, backed by a lot of trials in miscarriages & approved by FDA and in over 115 countries.
• Dydrogesterone scores over oral micronized as it has greater bioavailability, dose is only 10 mg so negligible unwanted effects, and has documented evidence of immunomodulation.
• Threatened abortion – 40mg dydrogesterone loading dose followed by 20-30 mg daily till 7 days after bleeding stops. Restart if it recurs.
• Recurrent miscarriage – 10mg dydrogesterone twice daily till 20 weeks of pregnancy.
