Guidelines for Dydrogesterone and Bed Rest in Abortion Management
Dydrogesterone for Threatened Abortion
Dydrogesterone 40 mg stat dose followed by 10 mg twice daily for one week significantly reduces miscarriage rates in threatened abortion, with a 95.9% pregnancy continuation rate compared to 86.3% with conservative management alone. 1
Evidence for Dydrogesterone Use
First trimester threatened abortion: Dydrogesterone treatment reduces miscarriage rates by 47% (odds ratio 0.47, CI 0.31-0.7), with an absolute reduction of 11% in miscarriage incidence (13% vs 24% in controls). 2
Dosing regimen: The standard protocol involves 40 mg stat dose followed by 10 mg twice daily for one week when vaginal bleeding occurs before 13 weeks gestation. 1
Mechanism of action: Dydrogesterone increases progesterone-induced blocking factor (PIBF) concentrations, which has anti-abortive effects by modulating maternal immune response. 3
Recurrent Spontaneous Abortion Prevention
For women with history of recurrent miscarriage: Dydrogesterone 10 mg twice daily started immediately after pregnancy confirmation and continued until 12 weeks gestation reduces abortion rates from 29% (controls) to 13.4%. 4
Treatment initiation: Begin as soon as pregnancy is confirmed in women with history of recurrent unexplained spontaneous abortion (mean 3.5 prior abortions). 4
Safety Profile
Dydrogesterone demonstrates minimal adverse effects and side effects across multiple studies involving 1,380 patients. 2
No differences in pregnancy complications or congenital abnormalities compared to controls. 4
Bed Rest: No Evidence-Based Recommendation
The available guidelines do not support bed rest as an evidence-based intervention for threatened abortion or miscarriage prevention. The evidence focuses on progestogen therapy rather than bed rest, which was used only as a control/standard care comparator in studies. 1, 2
Key Clinical Pitfalls
Do not rely on bed rest alone: Studies comparing dydrogesterone to "conservative therapy" (which included bed rest) showed significantly better outcomes with active hormonal treatment. 1
Timing matters: Dydrogesterone is most effective when a viable fetus has been confirmed by ultrasound at the time of threatened abortion. 5
Exclude recurrent miscarriage history in acute threatened abortion studies: Women with history of recurrent miscarriage require different treatment protocols (continuous therapy until 12 weeks vs one-week course). 1, 4
Important Context: Progestogens NOT Indicated for Preterm Birth Prevention
While dydrogesterone is effective for threatened abortion, different progestogens are recommended for preterm birth prevention: 17-alpha-hydroxyprogesterone caproate 250 mg IM weekly (16-20 weeks until 36 weeks) for singleton gestations with prior preterm birth, or vaginal progesterone for short cervical length. 6
- Progestogens have no proven benefit for multiple gestations, active preterm labor, or preterm premature rupture of membranes. 6