Dr Hafiz Sami Ullah,Dr Umar Iqbal,Dr Shumaila Naz
Most recent publications offer the opportunity not only to look at large studies, but also to be able to compare the effect of the use of micronized progesterone or dydrogesterone for prevention of recurrent (habitual) miscarriage. Micronized progesterone and dydrogesterone have a similar partial effect pattern, which does not induce unwanted effects, when used in pregnancy. Also their major actions regarding implantation, preparation of the endometrium, blood flow increase, spiral artery development, uterine quiescence, cervical rigidity and protection of the semi-allogenic fetus not to be attacked by the maternal immune system, for instance regulating the Th1- and Th2-cytokines to establish and continue to have a dominance of Th2-cytokine action and protection against these effects which are associated with lower circulating progesterone. Both studies under consideration have included women with a history of three or more previous miscarriages and other non-endocrine or endocrine abnormalities have been ruled out. Under these provisions prevention of recurrent (habitual) miscarriage compared with a placebo group and a control group without a history of recurrent (habitual) miscarriage in a prospective, randomized fashion resulted in the dydrogesterone group in a recurrent (habitual) miscarriage rate of 6.9%, placebo group 16.8% and the control group 3.5%. The dose was 2 x 10 mg daily starting between 4-8 weeks of gestation until the 20st weeks of gestation. In 2015 an even larger study was done with micronized progesterone with a dose of micronized progesterone 2 x 400 mg a day vaginally. This application was started not later than 6 weeks of gestation and ended at 12 weeks of gestation. The live birth rate was not significant between the groups (65,8 % for micronized progesterone versus 63,3% placebo(RR1.04; 95%CI, 0,99-1,15) . Together with other studies this indicates that dydrogesterone significantly improves pregnancy outcome in contrast to vaginal progesterone in women with recurrent pregnancy loss. Keywords: Progesterone; Dydrogesterone; Recurrent (habitual) miscarriage.