Progestogen therapy in threatened miscarriage and unexplained recurrent pregnancy loss: Recommendations by the Thai interest group

Aim: Threatened miscarriage and unexplained recurrent pregnancy loss (RPL) pose significant physical and psychological challenges for women and their families globally. The lack of local guidelines and variations in recommendations by existing guidelines result in inconsistent management of these conditions in Thailand. The Thai interest group aims to provide recommendations to healthcare providers for the use of progesterone supplementation in women experiencing threatened miscarriage and unexplained RPL. Methods: Existing guidelines and relevant studies were reviewed to explore the role of oral, vaginal, and injectable progestogens. In the present evidence-based recommendations, the Thai interest group delineated effective diagnostic and therapeutic strategies for managing patients with threatened miscarriages and unexplained RPL. Results: Treatment initiation for unexplained RPL is recommended after experiencing two or more pregnancy losses, regardless of consecutive occurrences. Oral progestogen (dydrogesterone) is recommended for the management of both threatened miscarriage and unexplained RPL. Exceeding 200 mg of micronized vaginal progesterone (MVP) per intake is not advisable for threatened miscarriage or preventing recurrent miscarriage because of luteal phase insufficiency. Treatment with intramuscular injection progestin should be continued at a dosage of 250 mg twice weekly for several weeks. Additionally, patient experiences and safety concerns related to MVP and injectable progestogens are discussed. Conclusion: These inaugural evidence-based Thai recommendations can be applied in regional healthcare settings for improved outcomes in threatened miscarriage and unexplained RPL. Further research is needed to better understand the epidemiology and etiology of these conditions in Thailand.