Assessment of Sub-endometrial Blood Flow Parameters Following Oral Dydrogesterone versus Micronized Vaginal Progesterone in Women with Idiopathic Recurrent Miscarriage

Abstract

Background: Recurrent pregnancy loss is an important reproductive health issue, affecting 2%–5% of couples. An unsupportive endometrium, leading to abnormal implantation, is considered to be one of the key factors contributing to idiopathic recurrent spontaneous miscarriage (IRSM). The aim of this work was to evaluate differences in uteroplacental blood flow and pregnancy outcome in women with idiopathic recurrent spontaneous miscarriage (IRSM) following administration of micronized vaginal progesterone versus oral dydrogesteron. Materials and Methods: This prospective, randomized-controlled study comprised 90 pregnant women who came to outpatient clinic of obstetrics  .All women had a singleton pregnancy with active cardiac pulsations at gestational age between 5-8 weeks Pregnant women in the study group were randomly distributed into: Group {A}: 30 pregnant women received 10 mg of oral dydrogesterone (Duphaston; Abbott Company) twice daily.Group {B}: 30 pregnant women received 200 mg micronized vaginal progesterone (Prontogest) twice-daily. Control group:30 pregnant women without history of recurrent miscarriage served as controls and they received folic acid as placebo. Results: comparing the Doppler indices before progesterone supplementation, the mean resistance index (RI) was statistically significant less in the control group compared with both study groups (A&B) (P=0.012, P=0.005 respectively) .Moreover, pulsatility index (PI) was statistically significant less in the control group compared with both study groups (A&B) (P=0.026, P=0.05 respectively) .Paralleled to that, the S/D ratio was statistically significant less in control group compared with both group A &B (P=0.43, & P=0.019respectively) .In addition, the mean PSV was significantly higher in control group  compared to group B (P=0.047) and was higher in control group than group A with nearly significant P value. Conclusion: Considerable improvement in uteroplacental blood flow parameters of pregnant women with IRSM is evident with progesterone supplementation.