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Meta-Analysis
. 2017:2017:3616875.
doi: 10.1155/2017/3616875. Epub 2017 Dec 17.

The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion: A Systematic Review and Meta-Analysis

Hee Joong Lee  1 , Tae Chul Park  1 , Jae Hoon Kim  2 , Errol Norwitz  3 , Banghyun Lee  4
Affiliations
Meta-Analysis

The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion: A Systematic Review and Meta-Analysis

Hee Joong Lee et al. Biomed Res Int. 2017.

Abstract

Objective: To conduct systematic analyses to evaluate the efficacy of progesterone therapy for the prevention of miscarriages in pregnant women experiencing threatened abortion.

Methods: In November 2016, we performed a systematic literature search and identified 51 articles in PubMed, Embase, and Cochrane databases. We identified nine randomized trials that included 913 pregnant women (including 322 treated with oral dydrogesterone, 213 treated with vaginal progesterone, and 378 control subjects) who met the selection criteria.

Results: The incidence of miscarriage was significantly lower in the total progesterone group than in the control group (13.0% versus 21.7%; odds ratio, 0.53; 95% confidence interval (CI), 0.36 to 0.78; P = 0.001; I2, 0%). Moreover, the incidence of miscarriage was significantly lower in the oral dydrogesterone group than in the control group (11.7% versus 22.6%; odds ratio, 0.43; 95% CI, 0.26 to 0.71; P = 0.001; I2, 0%) and was lower in the vaginal progesterone group than in the control group, although this difference was nonsignificant (15.4% versus 20.3%; odds ratio, 0.72; 95% CI, 0.39 to 1.34; P = 0.30; I2, 0%). However, the incidence of miscarriage was not different between the oral dydrogesterone and vaginal progesterone groups.

Conclusion: Progesterone therapy, especially oral dydrogesterone, can effectively prevent miscarriage in pregnant women experiencing threatened abortion.

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Figures

Figure 1
Figure 1
Flow chart of the procedure used for study selection.
Figure 2
Figure 2
Forest plots and risk of bias: risk of miscarriage in pregnant women experiencing threatened abortion based on the route of progesterone administration. (a) Total progesterone versus control treatments. (b) Oral dydrogesterone versus control treatments. (c) Vaginal progesterone versus control treatments. (d) Oral dydrogesterone versus vaginal progesterone treatments. The risk of bias for each metric was assessed as low (+), high (−), or unclear (blank) for all the included studies as follows: A, random sequence generation (selection bias); B, allocation concealment (selection bias); C, blinding of the participants and personnel (performance bias); D, blinding of the outcome assessment (detection bias); E, incomplete outcome data (attrition bias); F, selective reporting (reporting bias); G, other bias. M-H, Mantel-Haenszel; CI, confidence interval.
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