Early pregnancy bleeding and threatened miscarriage: Your questions answered

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Educational Activities (EA)
These are activities that expand general practice knowledge, skills and attitudes, related to your scope of practice.

RP
0.5 mins

Reviewing Performance (RP)
These are activities that require reflection on feedback about your work.

MO
0 mins

Measuring Outcomes (MO)
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Description

The questions answered in this podcast are listed below.
They were compiled by GPs and professional attendees at our face-to-face seminars around Australia

  1. Tell us a little bit more about your own career path and how you came to be interested in optimising the chances of a healthy full-term pregnancy?
  2. What’s the trade name of micronised progesterone?
  3. Are there any side effects of progesterone that should be discussed with any woman who’s thinking about using it?
  4. Can 400 milligrams of progesterone be given PV, PR or PO, and are all routes equally effective?
  5. What is the rule of 10s?
  6. For a young couple who already have a child and then have two consecutive miscarriages, does the rule of 10 still apply?
  7. With regards to counting miscarriages, is this per baby or per pregnancy? So, if it’s a multiple pregnancy, is the loss of twins considered one or two miscarriages?
  8. When and how do you decide on progesterone in early pregnancy?
  9. Are there any nasal route options for progesterone?
  10. Would you consider progesterone for all women with early pregnancy bleeding, even without a history of miscarriage?
  11. Is it appropriate to start progesterone after ovulation, before a positive pregnancy test in a woman with recurrent miscarriage?
  12. Do you start progesterone even before PV bleeding and if so at what gestational age is it safe to do so?
  13. How many weeks do we give progesterone for women with a history of recurrent miscarriage?
  14. In the case of two miscarriages and early pregnancy bleeding, should progesterone be prescribed before ultrasound confirmation or do you need to wait until after it’s confirmed or ruled out an ectopic?
  15. When progesterone is indicated how long should it be prescribed? Should you keep going until the bleeding stops, or are there other parameters to guide this decision?
  16. In a woman over 40 with early pregnancy bleeding does progesterone prolong a pregnancy that would otherwise have miscarried naturally due to aneuploidy? Does it increase the risk of missed miscarriage?
  17. I have many women with recurrent miscarriages (more than two) and our early pregnancy assessment service won’t start them on progesterone. Why do you think this is the case?
  18. Do you have any good websites or resources that you could recommend on the topic of progesterone and miscarriage?

 

Expert: Emeritus Prof William Ledger, Fertility Specialist

Host: Dr Terri Foran, Sexual Health Physician

Total time: 25 mins

 

Recommended resource:

 

Last Updated: 12 Sep, 2025

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Emeritus Prof William Ledger

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Emeritus Prof William Ledger

Fertility Specialist; City Fertility Sydney, Emeritus Professor of Obstetrics and Gynaecology; School of Medicine, University of New South Wales

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