Wang Xiao-Xue, Luo Qing, Bai Wen-Pei
Department of Gynecology and Obstetrics, Capital Medical University Affiliated Shijitan Hospital, Beijing, China.
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China.
J Obstet Gynaecol Res. 2019 Apr;45(4):794-802. doi: 10.1111/jog.13909. Epub 2019 Jan 10.
To investigate whether treatment with progesterone would decrease the incidence of miscarriage in women who faced threatened miscarriage.
Randomized controlled trials (RCT) were identified by searching PubMed, Embase, Cochrane Library and Web of Science. Trials were included if they compared progesterone with placebo, no treatment or any other treatment given in an effort to treat threatened miscarriage. Pregnant prophylaxis drugs were not included without strict progesterone type, language and progesterone management. The primary outcome was the incidence of miscarriage. The summary measures were reported as relative risk (RR) with 95% confidence interval (CI).
Eight RCT including 845 women who faced threatened miscarriage were analyzed. Pooled data from the eight trials showed that women with threatened miscarriage who were randomized to the progesterone group had a lower risk of threatened miscarriage (RR = 0.64, 95% CI 0.48-0.85). Dydrogesterone was shown to have a lower risk of miscarriage (RR = 0.49, 95% CI 0.33-0.75) than natural progesterone (RR = 0.69, 95% CI 0.40-1.19). Oral management was demonstrated to have a lower risk of miscarriage (RR = 0.55, 95% CI 0.38-0.79) compared with vaginal administration (RR = 0.58, 95% CI 0.28-1.21).
Our findings show that progesterone agents are effective in reducing the incidence of miscarriage in threatened miscarriage. Dydrogesterone, but not natural progesterone, was associated with a lower risk of miscarriage. Given the limitations of the studies included in our meta-analysis, it is difficult to recommend route and dose of progesterone therapy. Further head-to-head trials of gestational weeks and long-time follow-up are required.
探讨孕激素治疗是否会降低面临先兆流产的女性流产的发生率。
通过检索PubMed、Embase、Cochrane图书馆和科学网来识别随机对照试验（RCT）。如果试验将孕激素与安慰剂、不治疗或为治疗先兆流产而给予的任何其他治疗进行比较，则纳入该试验。不包括没有严格孕激素类型、语言和孕激素管理的孕期预防药物。主要结局是流产的发生率。汇总测量结果报告为相对风险（RR）及95%置信区间（CI）。
分析了八项RCT，共纳入845名面临先兆流产的女性。八项试验的汇总数据表明，随机分配到孕激素组的先兆流产女性发生先兆流产的风险较低（RR = 0.64，95% CI 0.48 - 0.85）。与天然孕激素（RR = 0.69，95% CI 0.40 - 1.19）相比，地屈孕酮显示出较低的流产风险（RR = 0.49，95% CI 0.33 - 0.75）。与阴道给药（RR = 0.58，95% CI 0.28 - 1.21）相比，口服给药显示出较低的流产风险（RR = 0.55，95% CI 0.38 - 0.79）。
我们的研究结果表明，孕激素制剂可有效降低先兆流产中流产的发生率。地屈孕酮而非天然孕激素与较低的流产风险相关。鉴于我们荟萃分析中纳入研究的局限性，很难推荐孕激素治疗的途径和剂量。需要进一步进行孕周的直接比较试验和长期随访。
