Human chorionic gonadotrophin for threatened miscarriage

(Review)

Devaseelan P, Fogarty PP, Regan L

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library

2010, Issue 5

http://www.thecochranelibrary.com

Human chorionic gonadotrophin for threatened miscarriage (Review)

Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

[Intervention Review]

Human chorionic gonadotrophin for threatened miscarriage

Priscilla Devaseelan1, Paul P Fogarty2 , Lesley Regan3

1Department of Obstetrics and Gynaecology, Craigavon Area Hospital, Portadown, UK. 2Department of Obstetrics and Gynaecology,

Ulster Hospital, Belfast, UK. 3Department of Obstetrics and Gynaecology, St Mary’s Hospital, London, UK

Contact address: Priscilla Devaseelan, Department of Obstetrics and Gynaecology, Craigavon Area Hospital, 68, Lurgan Road, Porta-

down, Northern Ireland, BT63, UK. pdevaseelan@yahoo.co.uk.

Editorial group: Cochrane Pregnancy and Childbirth Group.

Publication status and date: New, published in Issue 5, 2010.

Review content assessed as up-to-date: 13 April 2010.

Citation: Devaseelan P, Fogarty PP, Regan L. Human chorionic gonadotrophin for threatened miscarriage. Cochrane Database of

Systematic Reviews 2010, Issue 5. Art. No.: CD007422. DOI: 10.1002/14651858.CD007422.pub2.

Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

A B S T R A C T

Background

Miscarriage is a common occurrence in early pregnancy. Human chorionic gonadotrophin (hCG) is secreted by the syncytiotrophoblast.

It promotes the corpus luteum to secrete progesterone and helps in maintaining the pregnancy. Hence, there has been much interest

in the use of hCG to treat threatened miscarriage.

Objectives

To assess the efficacy and safety of human chorionic gonadotropins in the treatment of threatened miscarriage.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (February 2010), the Cochrane Central Register of

Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1966 to 12 February 2010), EMBASE (1980 to 12 February

2010) and CINAHL (1989 to 12 February 2010). We also scanned the bibliographies of all located articles for any unidentified articles

and attempted to contact authors where necessary.

Selection criteria

All randomised controlled trials (RCTs) that assess the effectiveness of hCG in the treatment of threatened miscarriage compared

to placebo, no treatment of any other intervention, provided viability of the fetus has been confirmed by ultrasound before the

commencement of treatment.

Data collection and analysis

At least two authors assessed the trials for inclusion in the review and extracted the data.

Main results

Three studies (312 participants) were included in the review, one of which was of poor methodological quality. The meta-analysis

showed that there was no statistically significant difference in the incidence of miscarriage between hCG and ’no hCG’ (placebo or no

treatment) groups (Risk ratio (RR) 0.66; 95% confidence interval (CI) 0.42 to 1.05). When hCG and bed rest alone were compared,

there was a significant reduction in the risk of miscarriage (RR 0.47; 95% CI 0.27 to 0.82). This result should be interpreted with

caution, as one of the two trials from which this result is derived was of poor methodological quality. There was no report of adverse

effects of hCG on mother or baby. More good quality RCTs are urgently needed to assess the effects of hCG in threatened miscarriage.

Human chorionic gonadotrophin for threatened miscarriage (Review)

Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Authors’ conclusions

The current evidence does not support the routine use of hCG in the treatment of threatened miscarriage.

P L A I N L A N G U A G E S U M M A R Y

Human chorionic gonadotrophin for threatened miscarriage

Threatened miscarriage is a term used when a woman who is less than 24 weeks pregnant with a live baby experiences bleeding. The

mother has vaginal bleeding, with or without abdominal pain and cramps, but the cervix is closed. Miscarriage is a source of great

physical and psychological distress and is very common. Causes include chromosomal abnormalities in the fetus, when the mother

is older, has uterine or endocrine abnormalities or has polycystic ovarian syndrome. Human chorionic gonadotrophin (also called

hCG) is a hormone produced by the placenta and is known to help maintain the pregnancy. Hence there has been much interest

in the use of hCG for treating threatened miscarriage with the aim of preserving the pregnancy.This review of three trials (including

312 participants), one of which was of poor quality, found no evidence that hCG can be used as effective treatment for threatened

miscarriage. There was no report on adverse effects of hCG on the mother or baby. More good-quality research is needed to study the

impact of hCG on miscarriage.

Human chorionic gonadotrophin for threatened miscarriage (Review)

Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.