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.
The requirement for a scan before starting treatment with progesterone
The NICE guideline states that progesterone should only be used in women with vaginal bleeding in early pregnancy if they have a confirmed intrauterine pregnancy on ultrasound scan and a history of prior miscarriage. See Annex A. This is because progesterone can mask, and potentially worsen, other pathologies such as ectopic pregnancy and molar pregnancy. The requirement for an intrauterine pregnancy to be confirmed before treatment protects women with other pathologies from being prescribed progesterone when it is not clinically appropriate.