Threatened miscarriage and recurrent miscarriage: Expert opinions on progesterone therapy and treatment challenges/Dusuk tehdidi ve tekrarlayan dusuk: Progesteron tedavisine iliskin uzman gorusleri ve tedavi zorluklari

• Published in: Turkish journal of obstetrics and gynecology Vol. 20; no. 3; p. 242
• Main Authors: Demir, Suleyman Cansun, Gedikbasi, Ali, Timur, Hakan, Cetin, Cihan, Pala, Halil Gursoy, Gulumser, Cagri
• Format: Journal Article
• Language: English
• Published: Galenos Yayinevi Tic. Ltd 01.09.2023
• Subjects: Abortion, Habitual; Health aspects; Miscarriage; Prevention; Progesterone; Risk factors; Turkey
• DOI: 10.4274/tjod.galenos.2023.66789
• ISSN: 2149-9322

It is crucial to gain a better understanding of threatened and recurrent miscarriages, including the existing knowledge and unknowns, as well as to discuss medical approaches and assess the situation. These issues are outstanding problems, causing significant physical and emotional burdens on women and their families, not only in Turkey but also worldwide. This article aims to explore the topic of miscarriages, including the implications, challenges, and potential therapeutic approaches in Turkey. Nineteen statements were presented to 6 Turkish perinatologists and obstetricians and gynecologists to evaluate the management of threatened and recurrent miscarriage and to compare the results with literature recommendations in an expert opinion meeting. Turkish perinatologists and obstetricians & gynecologists provided their responses using a 5-point Likert scale and discussed every statement. Progesterone use, particularly oral dydrogesterone, was supported by most of the experts. Opinions varied on the preference for dydrogesterone in recurrent miscarriage treatment. Experts unanimously agreed on the efficacy and safety of dydrogesterone and its recommendation in guidelines for threatened and recurrent miscarriage. Regarding progesterone therapy, vaginal progesterone was not associated with an increased rate of live births. Side effects of vaginal and oral micronized progesterone were acknowledged, and compliance with oral progesterone treatment was generally agreed upon. Dydrogesterone activity and effectiveness in threatened miscarriage received positive responses, while opinions on its effectiveness in recurrent miscarriage were divided. The loading dose of dydrogesterone and the practice of checking blood progesterone levels had different opinions among experts.This manuscript provides valuable insights in the management of threatened and recurrent miscarriages, highlighting the role of progesterone therapy, specifically dydrogesterone, and the need for adherence to relevant guidelines. Further research and a national Turkish guideline are warranted to address areas of uncertainty and optimize the management of these conditions. Keywords: Threatened miscarriage, recurrent miscarriage, progesterone, treatment, diagnosis Dusuk tehdidi ve tekrarlayan dusuklerin daha iyi anlasilmasi, mevcut bilgi ve bilinmezliklerin incelenmesi, tibbi yaklasimlarin tartisilmasi ve durumun degerlendirilmesi son derece onemlidir. Bu durum, sadece Turkiye'de degil, ayni zamanda tum dunyadaki kadinlar ve aileleri uzerinde onemli fiziksel ve duygusal yukler yaratan onemli sorunlardir. Bu makale, Turkiye'de dusuk konusunu, sonuclarini, zorluklarini ve potansiyel terapotik yaklasimlari arastirmayi amaclamaktadir. Uzman gorusleri ile dusuk tehdidi ve tekrarlayan dusuk yonetimi ve literatur onerilerini degerlendirmek amaciyla 6 Turk perinatolog ve kadin hastaliklari & dogum uzmanina 19 onerme sunulmus ve uzman gorus toplantisinda sonuclar 5 puanlik Likert olcegi kullanilarak degerlendirilmistir. Turk perinatolog ve kadin hastaliklari & dogum uzmanlari, her onermeyi ayri ayri degerlendirmis ve tartismislardir. Uzmanlarin cevaplari daha sonra analiz edilmistir. Ozellikle oral didrogesteron dahil progesteron kullanimi, uzmanlarin cogunlugu tarafindan desteklenmistir. Ancak, didrogesteronun tekrarlayan dusuk tedavisindeki yeri konusunda gorusler farklilik gostermistir. Uzmanlar, didrogesteronun etkinligi ve guvenliligi ile dusuk tehdidi ve tekrarlayan dusuk tedavisinde kilavuzlardaki onerilerle ayni fikirde olmuslardir. Vajinal progesteronun canli dogum oraninda artisla iliskilendirilmedigi gorulmustur. Vajinal ve oral mikronize progesteronun yan etkileri ve oral progesteron tedavisine daha iyi uyum saglandigi genel olarak kabul gormustur. Didrogesteronun dusuk tehdidindeki etkinligi olumlu degerlendirilmis, ancak tekrarlayan dusukteki etkinligi konusunda farkli gorusler belirtilmistir. Didrogesteronun yukleme dozu seklinde kullanimi ve kan progesteron seviyelerinin kontrolu konusundaki uygulamalar arasinda farkli gorusler vardir. Bu yazi, dusuk tehdidi ve tekrarlayan dusuk yonetimi konusunda, progesteron tedavisinin, ozellikle didrogesteronun rolunu ve ilgili kilavuzlara uyumunu vurgulayan degerli gorusler sunmaktadir. Belirsizlik alanlarini ele almak ve bu durumlarin yonetimini optimize etmek icin daha fazla arastirma ve ulusal bir kilavuz gerekmektedir. Anahtar Kelimeler: Dusuk tehdidi, tekrarlayan dusuk, progesteron, tedavi, tani