유산 예방을 위한 질 미세화 프로게스테론의 임상적 적용: 최신 근거 종설

초록

Early pregnancy bleeding and recurrent miscarriage are common obstetric challenges associated with significant maternal anxiety and adverse pregnancy outcomes. Progesterone plays a central role in implantation, immune tolerance, and maintenance of early pregnancy. Recent large-scale randomized trials, including Progesterone in Recurrent Miscarriages and Progesterone in Spontaneous Miscarriage, have clarified the clinical utility of vaginal micronized progesterone in specific patient populations. This review summarizes the physiological role of progesterone, pharmacologic characteristics of vaginal micronized progesterone, and current evidence regarding its use in threatened and recurrent miscarriage, with emphasis on recent randomized trials and guideline recommendations. A narrative review was conducted based on major clinical trials, meta-analyses, and international guidelines including National Institute for Health and Care Excellence, Cochrane, and recent Lancet publications. Vaginal micronized progesterone does not improve live birth rates in women with unexplained recurrent miscarriage alone. However, in women with early pregnancy bleeding and a history of one or more previous miscarriages, progesterone significantly increases live birth rates. Safety data demonstrate no increased risk of congenital anomalies or neonatal complications.Vaginal micronized progesterone is recommended for women with early pregnancy bleeding and at least one prior miscarriage. Evidence supports its safety and clinical benefit in this subgroup. Further welldesigned trials are needed to refine optimal dosing and treatment duration.

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