Management of threatened miscarriage and recurrent miscarriage: guidance on use of progesterone
The Progesterone Pathway ensures that women who have had at least one previous miscarriage and present with early pregnancy bleeding are offered vaginal micronised progesterone, where it is clinically indicated, and provides guidance on asymptomatic women with four or more previous miscarriages.
Treatment regimen for recurrent miscarriage
Asymptomatic women with four or more previous miscarriages should be offered vaginal micronised progesterone (400 mg twice daily) from a positive urine pregnancy test until 12 weeks of gestation, where clinically appropriate. This regimen is based on the PROMISE study protocol that informed this document. Women considering treatment should be provided with verbal and written information on available evidence and potential risks/benefits, including that there is no conclusive trial evidence that progesterone reduces the risk of miscarriage including after 4 miscarriages.
As progesterone could be harmful in the event of an abnormally located (ectopic) pregnancy, an ultrasound scan should be provided at 6 weeks’ gestation, in order to confirm intrauterine gestation and potential viability. At the time of writing, there is no need to wait for an ultrasound scan prior to commencing vaginal micronised progesterone for asymptomatic women with 4 or more miscarriages.