Comparison of Dydrogesterone Alone Versus Dydrogesterone Plus HCG in Threatened Miscarriage (DYD-HCG)
Comparison of Dydrogesterone Alone With Dydrogesterone Plus Human Chorionic Gonadotrophin (HCG) in the Treatment of Threatened Miscarriage
This randomized controlled trial aims to compare the efficacy of Dydrogesterone alone versus Dydrogesterone combined with human chorionic gonadotrophin (HCG) in the treatment of threatened miscarriage in first trimester pregnancy.
Threatened miscarriage is defined as vaginal bleeding with abdominal or pelvic pain in early pregnancy with a closed cervical os. It is one of the most common complications of pregnancy and may lead to pregnancy loss if not managed appropriately.
In this study, eligible women aged 18-40 years presenting with threatened miscarriage will be randomly assigned into two groups. Group A will receive oral Dydrogesterone 10 mg twice daily, while Group B will receive oral Dydrogesterone 10 mg twice daily along with intramuscular human chorionic gonadotrophin (HCG) 5000 IU weekly up to 14 weeks of gestation.
The primary outcome is treatment efficacy, defined as absence of vaginal bleeding and pain score ≤4 on Visual Analogue Scale (VAS) after 14 days of treatment.
The results of this study will help determine whether the addition of HCG to Dydrogesterone provides superior clinical benefit in threatened miscarriage and may guide future treatment protocols.
Tutkimuksen yleiskatsaus
Tila
Interventio / Hoito
Yksityiskohtainen kuvaus
Threatened miscarriage is a common complication in early pregnancy, affecting a significant proportion of women in the first trimester. It is clinically defined by vaginal bleeding with or without abdominal pain while the cervical os remains closed. Although many pregnancies with early bleeding continue successfully, a considerable proportion may progress to miscarriage, making early and effective management essential.
Progesterone plays a key role in the maintenance of pregnancy by supporting endometrial stability and preventing uterine contractions. Dydrogesterone, a synthetic progesterone, is widely used for the management of threatened miscarriage. However, clinical outcomes remain variable, and additional therapeutic strategies are being explored.
Human chorionic gonadotrophin (HCG) is a glycoprotein hormone produced by the syncytiotrophoblast early in pregnancy. It supports corpus luteum function and progesterone production and may also have direct effects on uterine blood flow, angiogenesis, and endometrial receptivity. These mechanisms suggest a potential benefit of combining HCG with progesterone therapy.
This randomized controlled trial will be conducted in the Department of Obstetrics and Gynecology, PAF Hospital Islamabad after approval from the ethical review committee. A total of 100 women diagnosed with threatened miscarriage in the first trimester will be enrolled through consecutive non-probability sampling and randomly assigned into two equal groups.
Group A will receive oral Dydrogesterone 10 mg twice daily, while Group B will receive the same dose of Dydrogesterone along with intramuscular HCG 5000 IU weekly until 14 weeks of gestation.
Participants will be followed for 14 days after initiation of treatment. The primary outcome measure is treatment efficacy, defined as absence of vaginal bleeding and pain score ≤4 on Visual Analogue Scale (VAS). Secondary analysis will include comparison of efficacy between both groups using chi-square test, with p-value <0.05 considered statistically significant.
Data will be analyzed using SPSS version 24. Results of this study will provide evidence regarding the comparative effectiveness of combination therapy versus progesterone alone in the management of threatened miscarriage and may contribute to improved clinical guidelines in local population settings.
Opintotyyppi
Ilmoittautuminen (Todellinen)
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskelupaikat
-
-
Punjab Province
-
Islamabad, Punjab Province, Pakistan, 44000
- Pakistan Air Force Hospital, Islamabad
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-
Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
- Aikuinen
Hyväksyy terveitä vapaaehtoisia
Kuvaus
Inclusion Criteria:
- Women with singleton pregnancy diagnosed as threatened miscarriage in the first trimester
- Age 18 to 40 years
- Presence of vaginal bleeding with or without abdominal pain and closed cervical os
- Viable pregnancy confirmed on ultrasound (fetal cardiac activity present)
- Willing to provide written informed consent
Exclusion Criteria:
- History of oxytocin or prostaglandin use during current pregnancy
- History of abdominal trauma during pregnancy
- Septic abortion or signs of infection
- Hemodynamically unstable patients
- Known bleeding disorders
- Known uterine anomalies
- Failed or inevitable miscarriage at presentation
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Satunnaistettu
- Inventiomalli: Rinnakkaistehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
|---|---|
|
Kokeellinen: Dydrogesterone Alone Group
Participants in this arm will receive oral Dydrogesterone 10 mg twice daily as monotherapy for the treatment of threatened miscarriage in the first trimester.
The intervention will be continued as per study protocol until assessment of treatment efficacy at day 14.
This group will serve as the comparator for evaluating the effect of Dydrogesterone alone.
|
Dydrogesterone 10 mg administered orally twice daily for the treatment of threatened miscarriage during first trimester pregnancy.
|
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Kokeellinen: Dydrogesterone + HCG Group
Participants in this arm will receive oral Dydrogesterone 10 mg twice daily in combination with intramuscular human chorionic gonadotrophin (HCG) 5000 IU weekly until 14 weeks of gestation.
This combination therapy is being evaluated for its additional benefit over Dydrogesterone alone in the management of threatened miscarriage.
Treatment efficacy will be assessed at day 14 based on clinical improvement.
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Dydrogesterone 10 mg administered orally twice daily for the treatment of threatened miscarriage during first trimester pregnancy.
Human chorionic gonadotrophin 5000 IU administered intramuscularly once weekly until 14 weeks of gestation as adjunct therapy with Dydrogesterone.
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Number of Participants with Treatment Success as Assessed by Absence of Vaginal Bleeding and Visual Analogue Scale (VAS) Score
Aikaikkuna: 14 days after initiation of treatment
|
Treatment success is defined as the absence of vaginal bleeding AND a pain score ≤4 on the Visual Analogue Scale (VAS) after 14 days of treatment in women with threatened miscarriage.
The VAS is a continuous scale ranging from 0 (no pain) to 10 (worst possible pain), where lower scores indicate less pain and a better outcome.
|
14 days after initiation of treatment
|
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Proportion of Participants Achieving Treatment Success in Each Treatment Group
Aikaikkuna: 14 days after initiation of treatment
|
To compare the proportion of patients achieving treatment success between Dydrogesterone alone and Dydrogesterone plus human chorionic gonadotrophin (HCG) groups in threatened miscarriage.
Treatment success is defined as absence of vaginal bleeding and Visual Analogue Scale (VAS) score ≤4 (scale: 0-10, where 0 = no pain and 10 = worst possible pain; lower scores indicate better outcome).
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14 days after initiation of treatment
|
Muut tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Change in Visual Analogue Scale (VAS) Pain Score and Vaginal Bleeding Pattern
Aikaikkuna: 14 days after treatment initiation
|
To assess change in abdominal pain and vaginal bleeding patterns in both study groups during the follow-up period.
Pain will be assessed using the Visual Analogue Scale (VAS), a continuous scale from 0 (no pain) to 10 (worst possible pain), where lower scores indicate less pain and a better outcome.
Vaginal bleeding will be assessed as present/absent and by bleeding pattern (spotting, light, moderate, heavy).
Data will be reported as change from baseline to Day 14.
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14 days after treatment initiation
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Yhteistyökumppanit ja tutkijat
Julkaisuja ja hyödyllisiä linkkejä
Yleiset julkaisut
- Devall AJ, Papadopoulou A, Podesek M, Haas DM, Price MJ, Coomarasamy A, Gallos ID. Progestogens for preventing miscarriage: a network meta-analysis. Cochrane Database Syst Rev. 2021 Apr 19;4(4):CD013792. doi: 10.1002/14651858.CD013792.pub2.
- Haas DM, Hathaway TJ, Ramsey PS. Progestogen use for prevention of miscarriage: updated systematic review and meta-analysis. Obstetrics & Gynecology. 2021;137(3):503-512.
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Todellinen)
Ensisijainen valmistuminen (Todellinen)
Opintojen valmistuminen (Todellinen)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Avainsanat
Muita asiaankuuluvia MeSH-ehtoja
- Urogenitaaliset sairaudet
- Naisten virtsa- ja sukupuolielinten sairaudet ja raskauden komplikaatiot
- Raskauden komplikaatiot
- Abortti, uhattuna
- Hormonit
- Hormonit, hormonikorvikkeet ja hormoniantagonistit
- Peptidihormonit
- Peptidit
- Aminohapot, peptidit ja proteiinit
- Proteiinit
- Polisykliset yhdisteet
- Raskaat
- Raskaat
- Steroidit
- Sulatettu rengasyhdisteet
- Gonadotropiinit
- Istukanhormonit
- Raskausproteiinit
- Dydrogesteroni
- Koriongonadotropiini
Muut tutkimustunnusnumerot
- PAF-OBS-RCT-2025-26-01
- ERC/FPGMI/ /49/2025 (Muu tunniste: FAZAIA POST GRADUATE MEDICAL INSTITUTE, ISLAMABAD, ETHICAL REVIEW COMMITTEE)
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