The only progestogens approved for use in pregnancy: Progesterone, Dydrogesterone, and 17-Hydroxyprogesterone caproate.
Dydrogesterone has been shown to have a good safety profile with a low incidence of maternal complications and fetal safety profile when considering fetal complications such as low birth weight, neonatal death, and congenital anomalies.
Progestogen treatment in Pregnancy Loss (PL) and the importance of combining it with psychological support is discussed along with a summary of guidelines for treatment of PL and recommendations reflected in most clinical guidelines worldwide.
For Threatened PL, Progestogen supplementation until the second trimester is recommended by Australia and New Zealand, RANZCOG guidelines. Indonesian guidelines recommend all progesterone- Dydrogesterone followed by natural progesterone as oral, vaginal gel and 17-hydroxyprogesterone caproate.
Russian & Indian FOGSI recommend both micronized progesterone & Dydrogesterone for PL. In Philippines oral Dydrogesterone is preferred though intramuscular and vaginal progesterone are also available.
Whereas UK NICE guidelines recommend vaginal micronized progesterone and Vietnamese recommend intramuscular progesterone or along with Dydrogesterone and oral micronized progesterone.
International guidelines by European Progestin Club (EPC) recommend Dydrogesterone for threatened PL, as do National guidelines from Saudi Arabia, Malayasia, Chinese.
In contrast, Mexican guidelines state current evidence insufficient for progesterone use in threatened PL.
Additionally for Recurrent PL Israel guidelines also recommend progesterone support specifically Dydrogesterone for recurrent miscarriage, as do National guidelines from Taiwan, Indonesia, Philippines.
ASRM recommends empiric progestogen administration for RPL, whereas RCOG finds insufficient evidence to evaluate the effect of progesterone supplementation for RPL. ESHRE also finds no beneficial effect of vaginal progesterone and for use of Dydrogesterone, though effective, more trials are needed.
German, Austrian and Swiss societies guideline recommend synthetic progestogens, but not natural micronized progesterone for idiopathic recurrent miscarriage.
This review highlights that progestogen such as Dydrogesterone could be beneficial in the treatment of threatened and recurrent PL.