Progesterone treatment and childbirth

Pregnant lady pic for Progesterone treatment and childbirth.

Overview

The role of progesterone is so vital in childbirth that it recognizes as the pregnancy hormone. This hormone naturally secreted from the corpus luteum for  10 to 14 days until the placenta it’s functioning. In between 7 to 9 week of gestational period, the placenta is formed and maintain the pregnancy. Progesterone helps in successful implantation of the embryo by inducing the essential alteration of the uterine lining. Progesterone also improves maternal acceptance of embryo and by modulating maternal immune functioning and also prevent uterine contraction. All these supportive management prevent miscarriage and increase the rate of successful childbirth. In 2013, Facts Views Vis Obgyn journal published a literature review, which concluded that progestagens did not show a statistically significant difference between women receiving progestagens for preventing threatened miscarriage or miscarriage when compared to placebo, no treatment or other treatment. But this opinion has changed after the completion of currently conducted clinical research by the University of Birmingham.  

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Evidential support

On 8th May 2019, Dr. Adam Devall, Senior Clinical Trial Fellow at the University of Birmingham recommended that treating patients with progesterone increases the chances of childbirth in case of early bleeding and recurrent miscarriage. The research conducted by the team included 4,153 pregnant women who had early pregnancy bleeding. The average age group of the study participants was 31 years. This multi-centered randomized clinical trial was conducted at 48 hospitals across the UK. This placebo-controlled trial reported that progesterone administration helps to maintain the pregnancy and may help to reduce the incidence of miscarriage in women who had early pregnancy bleeding symptom. In comparing with placebo, a number of live birth increases in the treatment group after 34 weeks of the gestational period. This large scale clinical trial findings open the door for future to prevent miscarriage.

Role of Progesterone in Pregnancy

Progesterone is necessary for conceiving and maintain pregnancy. Progesterone helps to prepare a convenient uterine environment to conceive easily. Ovaries naturally produce progesterone after ovulation to develop uterine lining or thicken the endometrium. The aim of these physiological changes makes a favorable uterine condition for fertilization of the egg.

After fertilization, and embryo implantation, progesterone helps to nurture the fetus for further development in the womb. After the 8th week of the gestational period, the placenta takes over the responsibility of progesterone synthesis and increase progesterone production. 

Limitation of Progesterone administration

Progesterone supplementation is already recommended to prevent miscarriage. But the route of administration of the drug is a major barrier of this treatment process. Yet now proposed routes of progesterone administration are oral, vaginal and intramuscular. But all these routes have some limitations, such as

  • Great patient compliance with the oral route, but imparts some side effects, like headache, sleepiness, and nausea.
  • In the case of vaginal administration, progesterone concentration in the vagina is high, but minimal blood concentration can achieve.
  • There is a scope to develop non-septic abscesses at the injection site in case of intramuscular administration.

Progesterone and Assisted Reproductive Technology (ART)

In ART, progesterone is a common prescription medication. Fertility treatment prescribed during ART procedure may cause suppression of progesterone production. In certain ART procedures, unintended removal of progesterone-producing cells from ovaries is also a common incidence. Progesterone is recommended in some ART procedures, as clinicians found that limited release of progesterone or poorly development of follicles unable to produce enough progesterone to necessary for uterine lining development.

Different Progesterone Formulations

Dosage forms for vaginal insertion includes vaginal gel, vaginal suppositories, vaginal inserts, vaginal capsules, and vaginal injections.

Clinician prescribed the particular dosage for individual patients depending upon the patient’s convenience. 

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