Pregnancy loss. Treatment options
Authors:   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Astrakhantseva M.M. , Myasoutov A.I. ,   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Breusenko L.E. ,   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Shalina R.I. ,   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Latyshkevich O.A. ,   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation
Published: July 2021

Objective. To justify the selection of the most effective gestagen with an optimal safety profile in the treatment of patients with pregnancy loss. Patients and methods. A retrospective study of 93 records of patients with recurrent pregnancy loss (RPL) who were prescribed gestagens was made. The first group included 49 patients taking dydrogesterone; the second – 44 patients who received micronized progesterone (19 – orally/subgroup 2a/ and 25 – intravaginally/subgroup 2b/). In order to assess the effectiveness of therapy, prolongation of pregnancy up to 22 weeks was the study’s primary endpoint. The secondary endpoint was prolongation of pregnancy up to 34 weeks of gestation and live birth. Results. A positive subjective evaluation was found in 94% of women taking dydrogesterone and in 79.5% of women taking micronized progesterone (68.4% – orally and 88% – intravaginally). The total number of observations with adverse effects when taking dydrogesterone was significantly lower than in case of micronized progesterone: in 7 (16%) and 31 (72%), respectively (p < 0.05). Dull lower abdominal pain was significantly more frequent in oral administration of micronized progesterone compared with dydrogesterone: in 15 (79%) and 11 (22%), respectively (p < 0.05). In dydrogesterone and intravaginal administration of micronized progesterone, pain syndrome occurred with the same frequency. Bloody vaginal discharge was 2.5 times more frequent in group 2: in 4 (8%) patients of group 1 and in 10 (23%) patients in group 2 (p < 0.05). Moreover, bloody discharge remained significantly more often in case of vaginal administration of micronized progesterone (p < 0.05). In oral micronized progesterone, the difference with dydrogesterone was not significant. According to ultrasound data, hematomas that were not accompanied by bloody discharge were registered in 6 (12%) patients taking micronized progesterone, equally for oral and intravaginal administration. Against the background of receiving dydrogesterone, no hematomas were revealed according to ultrasound data. Against the administration of dydrogesterone, both primary and secondary results were achieved in all women. With the use of micronized progesterone, the primary result was achieved in 39 (88.6%), the secondary – in 38 (86%) patients. Early pregnancy loss was in 6 (14%) women of group 2: 5 (11%) had a spontaneous miscarriage before 14 weeks of gestation (intravaginal drug administration), one had premature birth at 32 weeks (oral drug administration). Conclusion. Dydrogesterone has the highest efficacy and optimal safety profile in the treatment of RPL; therefore, it can be considered as the gestagen of choice in early pregnancy. If it is impossible to prescribe dydrogesterone, preference should be given to micronized progesterone – intravaginal route of administration. Key words: dydrogesterone, micronized progesterone, pregnancy loss, progesterone