Threatened miscarriage and preterm birth – Your questions answered

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The questions answered in this podcast are listed below.
They were compiled by GPs and health professionals around Australia.

  1. If we initiate progesterone for a threatened miscarriage, and there is actually an underlying problem like aneuploidy, will this pregnancy eventually miscarry, or is there a risk the pregnancy continues when it should have miscarried – leading to later problems or poorer birth outcomes?
  2. Is vaginal administration of progesterone considered a parenteral delivery system?
  3. Is measuring progesterone helpful in early pregnancy for patient with previous miscarriage to decide whether to initiate progesterone use?
  4. Is there any value to check serum progesterone levels in early pregnancy and then commence vaginal progesterone if dropping?
  5. Is the dose of progesterone prescribed for threatened miscarriage the same as that for premature birth prevention?
  6. Shouldn’t we be just offering progesterone to everyone with threatened miscarriage or at least to anyone with one previous loss?
  7. If the beta-hCG is falling or sluggish, is there a role for progesterone support to prevent miscarriage?
  8. Does early pregnancy bleeding, with a suggested other cause (e.g. subchorionic haemorrhage) still warrant progesterone?
  9. Is there indication for progesterone use in recurrent miscarriage where no cause has been found?
  10. How early can you start progesterone for eligible pregnant woman?
  11. Can you please clarify – if a woman has a history of miscarriage, should vaginal progesterone be prescribed even without symptoms of threatened miscarriage? Does this recommendation change for the number of miscarriages and at what gestation should you prescribe progesterone for someone with a history of spontaneous preterm birth?
  12. Do we need to confirm fetal heart on ultrasound before we start progesterone? Can we start progesterone in someone who comes with light PV bleeding in early pregnancy with no fetal heart seen on ultrasound at 8 weeks by dates?
  13. If using progesterone for early pregnancy bleeding to 16 weeks – does the progesterone dose then need to be weaned down or can women just stop at 16 weeks?
  14. Are there any downsides to the use of PV progesterone apart from cost?
  15. What are the recommended investigations (if any) for recurrent miscarriage?
  16. Is there still an indication for low dose aspirin in the prevention of early pregnancy loss?
  17. What is the role of BV anaerobic vaginal infections in premature birth? Should asymptomatic BV be treated in pregnancy? Symptomatic? At what stage of pregnancy?
  18. If a fertile woman (aged 28) loses two early pregnancies with only 2 months between, could she have been trying too quickly for another pregnancy and what is the ideal birth spacing to reduce risk of premature birth?
  19. Will two small 10mm paraovarian cysts cause complications during pregnancy? Is any specific follow-up required?
  20. Is there any prognostic significance to subchorionic haemorrhage on scanning for bleeding in early pregnancy?
  21. Does having a cervical screening test at 12 weeks increase the risk of miscarriage?
  22. When should we check the cervical length in women with history of premature labour and if we know the cervix is short how early should the progesterone be started?
  23. Is the incidence of stillbirth increasing? I’ve seen this in three of my patients over the past year, all between 32-36 weeks.  All were otherwise healthy and under hospital antenatal care.

 

Host: Dr Terri Foran, Sexual Health Physician

Guest: Prof William Ledger, Gynaecologist

Total time: 36 mins

 

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Last Updated: 24 Nov, 2023

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Gynaecologist; Royal Hospital for Women, UNSW

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