Didrogesteron vs. Progesteron: Düşük Tehdidinde Hangisi Daha Etkili?

Year 2024, , 715 - 719, 31.10.2024

Oğuzhan Günenc , Melike Geyik Bayman , Ümmügülsüm Esenkaya , Hümeyra Akgün , Nur Gözde Kulhan , Mehmet Kulhan

https://doi.org/10.54005/geneltip.1533209

Abstract

Amaç: İlk 20 haftalık hamilelik döneminde vajinal kanama ile belirginleşen abortus imminens, olumsuz sonuçlar doğurabilecek sık karşılaşılan bir komplikasyondur. Bu durumu yönetmek için yaygın olarak dydrogesteron ve mikronize progesteron reçete edilmektedir, ancak bu iki ilacın karşılaştırmalı etkinliği halen tartışılmaktadır. Bu çalışmanın amacı, düşük tehdidini tedavi etmede dydrogesteron ve mikronize progesteronun etkinliğini ve güvenliğini değerlendirmektir.
Yöntemler: Hastanemizde retrospektif vaka-kontrol çalışması yapıldı ve vajinal kanama ile başvuran 6 ila 20 haftalık 123 hamile kadın dahil edildi. Katılımcılar dydrogesteron (n=56) veya mikronize progesteron (n=67) almalarına göre iki gruba ayrıldı. Düşük oranları, erken doğum ve doğum şekli gibi hamilelik sonuçları kaydedildi ve SPSS yazılımı kullanılarak analiz edildi.
Sonuçlar: Düşük oranı dydrogesteron grubunda (%9,6), progesteron grubuna kıyasla (%5,9) biraz daha yüksek olmasına rağmen, bu fark istatistiksel olarak anlamlı değildi (p=0,729). Her iki grup da yüksek başarılı doğum oranları sergiledi ve aralarında anlamlı bir fark bulunmadı (p>0,05). Ayrıca, her iki grup arasında hamilelik komplikasyonları veya doğum şekli açısından anlamlı farklar gözlemlenmedi.
Sonuç: Hem dydrogesteron hem de mikronize progesteron, düşük tehdidini yönetmede etkili olup, hamilelik sonuçlarında anlamlı fark bulunmamıştır. Tedavi seçimi, hastanın toleransı ve yan etki profiline göre bireyselleştirilmelidir. Bu bulguları doğrulamak ve tedavi kılavuzlarını netleştirmek için daha büyük ölçekli, randomize çalışmalara ihtiyaç vardır.

Keywords

Didrogesteron, Düşük önleme, Progesteron, Progestin tedavisi, düşük tehdidi

Dydrogesterone vs. Progesterone: Which is More Effective in Threatened Miscarriage?

Abstract

Background/Aims: Threatened miscarriage, marked by vaginal bleeding during the first 20 weeks of pregnancy, is a frequent complication with potential adverse outcomes. Dydrogesterone and micronized progesterone are commonly prescribed to manage this condition, yet their comparative efficacy remains under debate. This study aims to evaluate the effectiveness and safety of dydrogesterone versus micronized progesterone in treating threatened miscarriage.
Methods: A retrospective case-control study was conducted at Our Hospital, including 123 pregnant women aged 6 to 20 weeks presenting with uterine bleeding. Participants were divided into two groups based on receiving either dydrogesterone (n=56) or micronized progesterone (n=67). Pregnancy outcomes, including miscarriage rates, preterm labor, and mode of delivery, were recorded and analyzed using SPSS software.
Results: The miscarriage rate was slightly higher in the dydrogesterone group (9.6%) compared to the progesterone group (5.9%), though this difference was not statistically significant (p=0.729). Both groups exhibited high rates of successful delivery, with no significant difference between them (p>0.05). Additionally, no significant differences were observed in the incidence of pregnancy complications or mode of delivery between the two groups.
Conclusion: Both dydrogesterone and micronized progesterone are effective in managing threatened miscarriage, with no significant differences in pregnancy outcomes. The choice of treatment should be individualized based on patient tolerance and side effect profiles. Further large-scale, randomized trials are needed to confirm these findings and refine treatment guidelines.

Keywords

Dydrogesterone, Miscarriage prevention, Progesterone, Progestin therapy, Threatened miscarriage

Ethical Statement

This study was approved by the Ethics Committee for Non-Drug and Non-Medical Device Research of KTO-Karatay University with the document date and number: 01.07.2024-87661 and the decision number 2024/64.

Supporting Institution

This research received no specific grant from any funding agency in the public, commercial, or not-forprofit sectors

References

• Bolger LA, O'Riordan N, Allen C. A rapid improvement event: progesterone prescribing in prevention of miscarriage. BMJ Open Qual. 2024;13(1).
• Duncan WC. Did the NICE guideline for progesterone treatment of threatened miscarriage get it right? Reprod Fertil. 2022;3(2):C4-c6.
• Devall AJ, Papadopoulou A, Podesek M, Haas DM, Price MJ, Coomarasamy A, et al. Progestogens for preventing miscarriage: a network meta-analysis. Cochrane Database Syst Rev. 2021;4(4):Cd013792.
• Mirza F, Patki A, Pexman-Fieth C. Dydrogesterone use in early pregnancy. Gynecological Endocrinology. 2016;32:106-97.
• Tetruashvili N, Shih E. Efficacy of Dydrogesterone in Threatened Miscarriage: a Systematic Review and Meta-analysis. DoctorRu. 2022.
• Carp H. A systematic review of dydrogesterone for the treatment of threatened miscarriage. Gynecological Endocrinology. 2012;28:983-90.
• Lou C, Wang C, Zhao Q, Jin F. Effect of dydrogesterone and progesterone on threatened miscarriage due to corpus luteum insufficiency. Am J Transl Res. 2021;13(5):4544-52.
• Kuptarak A, Phupong V. Oral dydrogesterone for prevention of miscarriage in threatened miscarriage: a randomized, double-blind, placebo-controlled trial. J Matern Fetal Neonatal Med. 2024;37(1):2333929.
• Shayna S, Celene Yan Yan H, Tan T, Allen J, Malhotra R, Truls Ø. Micronized Progesterone Compared With Dydrogesterone for Threatened Miscarriage: A Randomized Controlled Trial [328]. Obstetrics & Gynecology. 2015;125:104.
• Jia Yun SS, Allen J, Hui CY, Ku CW, Malhotra R, Truls Ø, et al. The randomised controlled trial of micronised progesterone and dydrogesterone (TRoMaD) for threatened miscarriage. European journal of obstetrics, gynecology, and reproductive biology. 2018;228:319-24.
• Hee-Joong L, Park T, Jae Hoon K, Norwitz E, Lee B. The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion: A Systematic Review and Meta-Analysis. BioMed Research International. 2017;2017.
• Ramachandhiran Udayar P. Dydrogesterone in threatened miscarriage: a Malaysian experience. Maturitas. 2009;65 Suppl 1.
• Carp H. Progestogens in the prevention of miscarriage. Hormone Molecular Biology and Clinical Investigation. 2016;27:55-62.
• Pandya M, Gopeenathan P, Gopinath P, Das S, Meenakshi S, Veena S. Evaluating the clinical efficacy and safety of progestogens in the management of threatened and recurrent miscarriage in early pregnancy- A review of the literature. Indian Journal of Obstetrics and Gynecology Research. 2016;3:157-66.