Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore, Singapore.
Duke-National University of Singapore Medical School, 8 College Road, 169857, Singapore, Singapore.
Sci Rep. 2020 Jun 4;10(1):9153. doi: 10.1038/s41598-020-66155-x.
Threatened miscarriage is a common gynaecological emergency, with up to 25% of women eventually progressing to spontaneous miscarriage. The uncertainty of pregnancy outcomes results in significant anxiety. However, there is currently no acceptable framework for triaging patients presenting with threatened miscarriage. We aim to evaluate the efficacy and safety of a novel clinical protocol using a single serum progesterone level to prognosticate and guide management of patients with threatened miscarriage. 1087 women presenting with threatened miscarriage were enrolled in the study. The primary outcome was spontaneous miscarriage by 16 weeks' gestation. Among the 77.9% (847/1087) of study participants with serum progesterone ≥ 35 nmol/L who were not treated with oral dydrogesterone, the miscarriage rate was 9.6% (81/847). This did not differ significantly from the 8.5% (31/364) miscarriage rate observed in our prior studies; p = 0.566. Among women with serum progesterone < 35 nmol/L who were treated with dydrogesterone, the miscarriage rate was 70.8% (170/240). Our novel clinical triage protocol using a single serum progesterone level allowed both effective risk stratification and a reduction in progestogen use with no significant adverse pregnancy outcomes. This protocol, based on a single serum progesterone cutoff, can be readily adapted for use in other healthcare institutions.
先兆流产是一种常见的妇科急症，多达 25%的女性最终会自然流产。妊娠结局的不确定性导致了明显的焦虑。然而，目前对于有先兆流产症状的患者的分诊还没有一个可接受的框架。我们旨在评估一种使用单一血清孕激素水平预测和指导先兆流产患者管理的新型临床方案的疗效和安全性。共有 1087 名有先兆流产症状的妇女参与了这项研究。主要结局是 16 周时自发流产。在未接受口服地屈孕酮治疗、血清孕激素水平≥35 nmol/L 的 77.9%（847/1087）研究参与者中，流产率为 9.6%（81/847）。与我们之前研究中观察到的 8.5%（31/364）的流产率相比，这没有显著差异；p=0.566。在接受地屈孕酮治疗、血清孕激素水平<35 nmol/L 的妇女中，流产率为 70.8%（170/240）。我们使用单一血清孕激素水平的新型临床分诊方案，既能有效进行风险分层，又能减少孕激素的使用，且妊娠结局无显著不良。该方案基于单一的血清孕激素截断值，可以很容易地在其他医疗机构中应用。
