Comparative Analysis of Vaginal and Rectal Progestogen Administration in Pregnant Women with Threatened Miscarriage Before 21 Weeks of Gestation

Abstract

Threatened miscarriage represents one of the most frequently encountered complications of early pregnancy, characterized predominantly by vaginal bleeding, cramps, and occasional cervical change without the expulsion of fetal tissue. Despite advances in obstetric management, the optimal therapeutic approach remains a subject of ongoing debate, particularly concerning the route of progesterone administration. Vaginal and rectal progesterone formulations are frequently used to support early gestation, yet comparative evidence on their relative efficacy remains limited. This prospective randomized controlled study aimed to evaluate and compare the effectiveness of vaginal versus rectal micronized progesterone administration in women with threatened miscarriage, focusing on pregnancy continuation, symptom resolution, and patient satisfaction. The study further sought to explore patient acceptability, tolerability, and the impact of treatment route on anxiety levels associated with early pregnancy complications. By adopting a multicenter design and incorporating patient-centered outcomes, the trial introduces valuable insight into both clinical and psycho-social dimensions of threatened miscarriage care. Findings demonstrated that vaginal administration resulted in higher pregnancy continuation rates (90.0% vs. 76.7%), faster symptom resolution, and markedly greater patient satisfaction compared with rectal administration. Moreover, the use of vaginal progesterone was associated with improved adherence and reduced discontinuation rates, emphasizing the importance of delivery comfort in early pregnancy therapeutics. The results suggest that tailoring treatment not only to physiological effectiveness but also to personal preference may enhance outcomes in women experiencing threatened miscarriage. These findings underscore the clinical utility of vaginal progesterone in the management of threatened miscarriage and support its preferential use in routine obstetric practice.