From the Research
The best next step in management for this patient is to administer progesterone supplementation until 10-12 weeks of gestation. Specifically, the patient should receive either vaginal progesterone suppositories (200-400 mg daily) or intramuscular progesterone (25-50 mg daily) 1. This is necessary because the corpus luteum, which was removed during the emergency surgery for ovarian torsion, is essential for maintaining early pregnancy by producing progesterone. During the first 7-9 weeks of pregnancy, the corpus luteum is the primary source of progesterone, which supports the endometrial lining and prevents miscarriage. By 10-12 weeks, the placenta takes over progesterone production in sufficient quantities to maintain the pregnancy independently. Without progesterone supplementation after corpus luteum removal at 8 weeks, the patient would be at high risk for pregnancy loss. The patient should be monitored with serial ultrasounds to confirm ongoing fetal viability until placental function is fully established. Once the pregnancy reaches 10-12 weeks, progesterone supplementation can be gradually discontinued as the placenta will have assumed the role of progesterone production. Some studies have compared the efficacy of different progestogen therapies, such as 17α-hydroxyprogesterone caproate and vaginal progesterone, but the most recent and highest quality evidence supports the use of vaginal progesterone for preventing preterm birth in women with a sonographically short cervix 2. Additionally, a study published in 2020 found that intramuscular 17α-hydroxyprogesterone caproate did not prevent midtrimester cervical shortening or prolong gestation in high-risk patients undergoing cervical length screening 3. However, the current scenario is different, and the primary concern is the loss of the corpus luteum and the need for progesterone supplementation to support the early pregnancy. Therefore, the focus should be on administering progesterone supplementation until 10-12 weeks of gestation, as recommended by the most recent and highest quality evidence. Key points to consider in the management of this patient include:
- The importance of progesterone supplementation after corpus luteum removal
- The need for serial ultrasounds to confirm ongoing fetal viability
- The gradual discontinuation of progesterone supplementation once the placenta takes over progesterone production
- The consideration of the most recent and highest quality evidence in guiding management decisions.