Efficacy of progestogens in the management of threatened miscarriage in women with multiple pregnancies resulting from assisted reproductive technologies

Abstract

Women with multiple pregnancies resulting from assisted reproductive technologies (ART) demonstrate higher incidence of miscarriage and obstetric complications than women in the general population. Gestagens are the mandatory therapy to prevent miscarriage in women with single pregnancies (level B evidence). Objective. To evaluate the efficacy of different progestogens (dydrogesterone and micronized progesterone) for the treatment of threatened miscarriage in women with multiple pregnancies resulting from ART. Patients and methods. This prospective cohort study included 75 women with multiple pregnancies resulting from ART and threatened miscarriage in the first trimester. Group 1 comprised 46 patients who received oral dydrogesterone at a dose of 40 mg/day. Group 2 comprised 29 patients who received oral micronized progesterone at a dose of 600 mg/day. In both groups, the symptoms of threatened miscarriage were eliminated within 2 weeks. All patients gave their informed consent for long-term supportive therapy with progesterone agents (dydrogesterone at a dose of 20 mg/day and micronized progesterone at a dose of 200 mg/day) up to 26 weeks of gestation without interruptions. Results. Treatment of threatened miscarriage in the first trimester using progestogens was effective in 93.6% of patients from both groups. Patients receiving progesterone developed cervical shortening twice as often as patients receiving dydrogesterone (55.2% vs 26.1%). Patients receiving vaginal progesterone were 4 times more likely to have bacterial vaginosis. Conclusion. Administration of dydrogesterone and micronized progesterone as a part of comprehensive treatment to prevent miscarriage in the first trimester with subsequent progestogen support up to 26 weeks of gestation was highly effective. Dydrogesterone was significantly more effective in prevention of obstetric complications. Key words: multiple pregnancy, assisted reproductive technologies, pregnancy after ART, posttransfer support, threatened early miscarriage, cervical weakness, dydrogesterone, micronized progesterone