PubMed Central:
Introduction
Threatened
miscarriage is a common disease during early pregnancy, with a morbidity of 30%
to 40%, which could develop into a complete miscarriage or dystocia without
timely treatment. Many pathogenic factors contribute to the threatened
miscarriage, of which lacking progestogens due to the endocrine dysfunction of
corpus luteum is one of the main culprits.
Therefore,
supplementation of progestogens is a primary therapeutic strategy for the
treatment of threatened miscarriage due to corpus luteum insufficiency, among
which progesterone and dydrogesterone are the leading medications in clinical
practice.
In this study, authors designed a prospective cohort study to compare the effect of droprogesterone and progesterone in the treatment of threatened miscarriage due to corpus luteum insufficiency.
Take Home Message:
In this
study, serum sex hormone levels were elevated and the preterm birth rate was
significantly reduced in patients treated with dydrogesterone. Also reported
that dydrogesterone could effectively reduce the preterm birth rate.
In
addition, the rate of postpartum hemorrhage and adverse effects were
significantly reduced in the dydrogesterone group of this study. Other studies have
also demonstrated that dydrogesterone could effectively reduce the incidence of
hypertension and preeclampsia during pregnancy, which may be one of the
mechanisms by which dydrogesterone could reduce the incidence of preterm birth
and postpartum hemorrhage.
Compared
with progesterone soft capsules, the advantages of dydrogesterone in the
treatment of patients with threatened miscarriage due to corpus luteum
insufficiency include:
① As a
progesterone analog, dydrogesterone can be quickly absorbed via oral
administration, and has a higher affinity and specificity for progesterone
receptors;
② It can
be orally administered, with few adverse effects and higher medication
compliance;
③ It
demonstrates a good immunomodulatory effect, effectively reduces maternal
immune response to embryos, and promotes embryo implantation;
④ It can
inhibit the synthesis and release of prostaglandins in the endometrium and
provide a favorable environment for embryo development.
Objective: To investigate the
efficacy and safety of dydrogesterone and progesterone in the treatment of
threatened miscarriage due to corpus luteum insufficiency.
Methods: A prospective cohort study
was designed and a total of 1,285 patients with threatened miscarriage due to
corpus luteum insufficiency were recruited, in which 665 participants received
dydrogesterone treatment (dydrogesterone group), and the other 620 received
progesterone treatment (progesterone group). The time for clinical symptom
relief, changes of sex hormone levels in serum, the rate of miscarriage
prevention, delivery outcome, and adverse effects were compared between the two
groups. XGBoost algorithm was applied to analyze the factors impacting the
efficacy and safety of each treatment.
Results: There was no significant
difference regarding the time for clinical symptom relief and the rate of
miscarriage prevention between the two groups. However, after 4 weeks of
treatment, compared with the progesterone group, the level of sex hormones was
significantly upregulated, while the preterm birth rate (9.65% vs. 14.04%), the
postpartum hemorrhage rate (3.10% vs. 5.62%), and the incidence of adverse
effects (17.44% vs. 32.58%) were considerably reduced in the dydrogesterone
group.
XGBoost algorithm analysis
demonstrated that dydrogesterone treatment was correlated with a lower
incidence of preterm birth rate, postpartum hemorrhage, and adverse effects,
ranking the 3rd, 2nd and 1st, respectively, in the weight of dependent
variables.
Conclusion: Compared with
progesterone, dydrogesterone can improve the delivery outcome and demonstrate a
higher safety in the treatment of threatened miscarriage due to corpus luteum
insufficiency.
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