PDF(Pubmed)
Abstract：
In November 2021, NICE updated its clinical guideline that covers the management of threatened miscarriage in the first trimester. They recommended offering vaginal micronised progesterone twice daily until 16 completed weeks of pregnancy in those with a previous miscarriage. However, the duration of treatment is not evidence based. In the major clinical trial that informed the guideline, there was no benefit in starting progesterone after 9 weeks and the full effect of progesterone was present at 12 weeks of pregnancy. There are theoretical risks impacting offspring health in later life after maternal pharmaceutical progesterone treatment. As the effect of progesterone seems to be complete by 12 weeks of gestation, we should consider carefully whether to follow the guidance and treat up to 16 weeks of pregnancy.
In November 2021, new guidelines were published about the management of bleeding in early pregnancy. If someone who has had a previous miscarriage starts bleeding, they should now be treated with progesterone as this slightly reduces the chance of miscarriage. The guideline says progesterone should be given if the pregnancy is in the womb, and potentially normal, until 16 weeks of pregnancy. However, in the big studies looking at progesterone\'s effect in reducing miscarriage the beneficial effects of progesterone were complete by 12 weeks of pregnancy. At that stage, it is the placenta and not the mother\'s ovary that makes the progesterone to support the pregnancy. We do not know the long-term effects of giving extra progesterone during pregnancy on the offspring. Some research has raised the possibility that there might be some adverse effects if progesterone is given for too long. Maybe the guidance should have suggested stopping at 12 weeks rather than 16 weeks of pregnancy.
In November 2021, new guidelines were published about the management of bleeding in early pregnancy. If someone who has had a previous miscarriage starts bleeding, they should now be treated with progesterone as this slightly reduces the chance of miscarriage. The guideline says progesterone should be given if the pregnancy is in the womb, and potentially normal, until 16 weeks of pregnancy. However, in the big studies looking at progesterone\'s effect in reducing miscarriage the beneficial effects of progesterone were complete by 12 weeks of pregnancy. At that stage, it is the placenta and not the mother\'s ovary that makes the progesterone to support the pregnancy. We do not know the long-term effects of giving extra progesterone during pregnancy on the offspring. Some research has raised the possibility that there might be some adverse effects if progesterone is given for too long. Maybe the guidance should have suggested stopping at 12 weeks rather than 16 weeks of pregnancy.
摘要：
2021年11月，NICE更新了其临床指南，涵盖了妊娠早期先兆流产的管理。他们建议在先前流产的人中每天两次提供阴道微粉化孕酮，直到怀孕16周。然而,治疗的持续时间不是基于证据。在为指南提供信息的主要临床试验中，在妊娠9周后开始孕酮治疗没有获益,孕酮的全部作用在妊娠12周时出现.在母体药物孕酮治疗后，存在影响后代健康的理论风险。由于孕酮的作用似乎在妊娠12周时已完成，我们应该仔细考虑是否遵循指导和治疗长达16周的怀孕。
2021年11月，发布了有关妊娠早期出血管理的新指南。如果以前流产过的人开始流血，他们现在应该用黄体酮治疗，因为这会稍微减少流产的机会。指南说，如果怀孕在子宫内，应该给予孕激素，可能是正常的，直到怀孕16周。然而,在大型研究中，观察孕酮在减少流产方面的作用，孕酮的有益作用在怀孕12周时已完全完成。在那个阶段,它是胎盘，而不是母亲的卵巢，使孕酮支持怀孕。我们不知道在怀孕期间给予额外的黄体酮对后代的长期影响。一些研究提出，如果给予孕酮太长时间，可能会有一些不良影响。也许指南应该建议在怀孕12周而不是16周停止。
2021年11月，发布了有关妊娠早期出血管理的新指南。如果以前流产过的人开始流血，他们现在应该用黄体酮治疗，因为这会稍微减少流产的机会。指南说，如果怀孕在子宫内，应该给予孕激素，可能是正常的，直到怀孕16周。然而,在大型研究中，观察孕酮在减少流产方面的作用，孕酮的有益作用在怀孕12周时已完全完成。在那个阶段,它是胎盘，而不是母亲的卵巢，使孕酮支持怀孕。我们不知道在怀孕期间给予额外的黄体酮对后代的长期影响。一些研究提出，如果给予孕酮太长时间，可能会有一些不良影响。也许指南应该建议在怀孕12周而不是16周停止。
