PROMISE TRIAL -Routine supplementation of Progesterone in pregnancy

 

Vaginal application of micronized progesterone  

Age related risk  mscarriage:- Many studies have noticed that during the age of  20  years  the risk of miscarriage  was found to be 10%     but the prevalence  rose rapidly after 30 % and reached  53%  in women   aged > 45 .There   is  a strong   recurrence risk of miscarriage   with an age  adjusted  ratio

What are the advantages of   Vaginal   application  of progesterone  Ans;-Vaginal   application  of progesterone            results in a rapid and semi selective effect on the uterus  which occurs due to local   counter current  transfer  from the vaginal vein blood     to the uterine arterial blood  . This   leads to an induction of greater concentrations in arterial blood to the uterus or urethra than in other arteries. The transfer is based on the blood flow and may also involve lymph vessels.

 

What are the effects of vaginal Progesterone?? Ans:-

Actions of natural micronized progesterone  such as  1) immune  modulatory   properties related to positive  2) regulation of  progesterone  induced blocking factor  , 3) Natural killer   cells and   4) protein coding gene modulation supports  endometrial implantation.

 

Serum progesterone & prediction of continuation of pregancy??  Can we predict possibility implantation or continuation of early pregancy with late luteal progesterone level  ,say day 23/day 24 ? What is the optimum Progesterone at this stage of stimulated / unstimaulted cycle??

Ans:-1)  levels of  < 5  ng/ml   were observed   to be associated   with a spontaneous   miscarriage   in 86% of cases   2)  but it becomes only  8% provided  serum Progesterone  is  20-25  ng/ ml . By and large in normal cycles  the level of progesterone is around     of >14 ng/ ml in the mid luteal  phase  for maintaining pregnancy ..

How to prevalence and causes of recurrent  pregnancy  loss .

 

What do we mean by  “The PROMISE trial    in 2015 “ pertaining to relevance of MNP(micronized Progesterone?? “  It (Trial)  showed that daily vaginal   progesterone  in first trimester   do not  increase   ongoing pregnancy    or live birth  rates in women   with unexplained  RM.

 

But a recent study    conducted to determine the effect   of administration of progesterone in the    luteal phase of   the cycle demonstrated reduced risk  of miscarriage  in women    with history of unexplained recurrent  miscarriage.