threatened miscarriage

Last edited 11/2021 and last reviewed 08/2022

Threatened abortion is the earliest stage of most spontaneous abortions. There is bleeding from the genital tract, but the cervix is closed and there is no discharge of products of conception.

Vaginal micronized progesterone in threatened miscarriage:

  • the effects of first-trimester use of vaginal micronized progesterone have been evaluated in 2 large, high-quality, multicenter placebo-controlled trials, one targeting women with unexplained recurrent miscarriages (the PROMISE [PROgesterone in recurrent MIScarriagE] trial) and the other targeting women with early pregnancy bleeding (the PRISM [PRogesterone In Spontaneous Miscarriage] trial) (1)

    • a key finding, first observed in the PROMISE trial, and then replicated in the PRISM trial, was that treatment with vaginal micronized progesterone 400 mg twice daily was associated with increasing live birth rates according to the number of previous miscarriages
    • therefore, women with a history of miscarriage who present with bleeding in early pregnancy may benefit from the use of vaginal micronized progesterone 400 mg twice daily