Women who experience early pregnancy bleeding and have been through a previous miscarriage will be offered a progesterone-based treatment in a bid to prevent pregnancy loss, under newly updated NHS guidelines.
The National Institute for Health and Care Excellence (Nice) has released re-worked guidance with regards to miscarriage. This says that women in these specific circumstances can be given the option of taking a drug formulated with the hormone.
The news has been welcomed by baby loss charities – Tommy’s, which carried out the research which the new guidance is based on – said that this decision will 'help save babies’ lives and spare parents heartache.'
Who will the progesterone treatment be offered to?
However, Nice cautioned the drug would not be able to prevent every miscarriage and would only be appropriate for use by some women. According to the body, right now, these are women who have previously had a miscarriage and who are now pregnant – with this being confirmed by a scan – and who are experiencing bleeding in early pregnancy.
If the foetus' heartbeat is confirmed, then this treatment is recommended to continue until 16 weeks of pregnancy have gone by.
Eligible women can be offered 400mg of micronised progesterone to take twice daily.
The Nice independent guidelines committee said that the medication should not be offered to women who are bleeding in early pregnancy but have no previous experience of miscarriage, and not to pregnant women who have had a miscarriage in the past, but who have no early pregnancy bleeding.
Further research is needed to assess the impact of the medication in these instances, it said.
Prof Gillian Leng, Nice’s chief executive, said: 'It is devastating for a woman to experience a miscarriage, so we are pleased to recommend progesterone for those women who experience bleeding in early pregnancy and who have had at least one miscarriage as a new treatment option.
'The research evidence is clear that progesterone will not be able to prevent every miscarriage, and therefore our committee has called for more research to be carried out in this area. However, it will be of benefit to some women and as an inexpensive treatment option can be made available to women on the NHS from today.'
How many miscarriages might progesterone treatment prevent?
Arri Coomarasamy, Professor of Gynaecology & Reproductive Medicine at the University of Birmingham and Director of Tommy’s National Centre for Miscarriage Research, who led the PRISM and PROMISE trials, which the guidelines are based on, said: 'After many years researching the use of progesterone and working to make treatment more accessible, today’s new miscarriage care guidelines from NICE include a very welcome change.
'Our research has shown that progesterone is an effective and safe treatment option, which could prevent 8,450 miscarriages a year in the UK – but we know it’s not yet reaching everyone who might benefit. This recommendation from NICE is an important step in tackling the current variation in miscarriage services across the country and preventing these losses wherever possible.'
Speaking to the Guardian, Dr Edward Morris, the president of the Royal College of Obstetricians and Gynaecologists, said: 'The advice in the new Nice guideline on ectopic pregnancy and miscarriage reflects what we are proposing in our draft green-top guideline on recurrent miscarriage, which is that women who experience early pregnancy bleeding and who have a history of one or more previous miscarriages be given progesterone for up to 16 weeks.
'It is positive that Nice has acknowledged the latest evidence available from the Prism trial and how these findings can translate into tangible action for women experiencing recurrent miscarriage.
'We do, however, still have a way to go before understanding the best treatments for women experiencing unexplained pregnancy loss, and would welcome further research in this area.'
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