Comparative Outcomes of Cyclogest Pessary Versus Conservative Management in Threatened Miscarriage

Objective: To compare Cyclogest pessary with conservative management in women with threatened miscarriage with regard to pregnancy continuation rate, maternal morbidity and neonatal outcomes. Methodology: This 12-month prospective cohort study was conducted from January 1, 2022, to December 31, 2022, at the Department of Obstetrics and Gynecology, Hayatabad Medical Complex, Peshawar, The institutional review board approved the study protocol, and all subjects gave written informed consent for enrolment. Participants were grouped according to clinical management into two groups. Cyclogest Group (n=100) - administration of 400 mg/day of vaginal progesterone (Cyclogest pessary) until 20 weeks of gestation or symptom resolution. Conservative Management Group (n = 70): Women in this group received an alternative form of progesterone support (e.g., oral or intramuscular progesterone) to ensure that all participants received some form of progesterone therapy. Results: Mean age for the Cyclogest group was 28.5 ± 5.2 years and 27.8 ± 5.6 years for the conservative group (p = 0.23). Both groups were comparable in terms of gravidity, parity, and gestational age at presentation (p > 0.05). The continuation of pregnancy beyond 20 weeks was significantly higher in the Cyclogest group compared to the conservative group (87% vs. 70%, p = 0.004). The rate of complete miscarriage was lower in the Cyclogest group (13%) compared to the conservative group (30%). Maternal morbidity rates were comparable between the two groups, with no significant differences in postpartum hemorrhage, infection, or hypertensive disorders (p > 0.05). Conclusion: Cyclogest pessary significantly improves pregnancy continuation rates in women with threatened miscarriage compared to conservative management. Further randomized controlled trials are needed to validate these findings and refine treatment guidelines.