ObGyn/Pregnancy issues/progesterone to prevent miscarriage
Last year, I was pregnant with twins following IVF and was put on progesterone pessaries (2x400mg per day) by my private IVF consultant. This is normal procedure up to 12 weeks but he told me that since my pregnancy was very high risk, the NHS doctors would leave me on it for the duration of my pregnanc. My risk factors were twins, IVF, severe OHSS from IVF procedure with 27 eggs retrieved, 2 previous LOOP excisions of the cervix and my age being 40. The NHS doctors did not see that this was necessary as there is little evidence to support the use of progesterone after 12 weeks and took me off it at 13 weeks. I weaned myself off it taking 1 a day for the last 2 weeks as I had read a lot about withdrawal bleeding. Within 2 days of going to 1 a day, I started spotting with brown discharge. This got heavier when I stopped the progesterone completely and within 5 days of stopping, I went into pre-term labour and lost my twins at 17 weeks. I have since found out that I had Chorioamnionitis in one of the placentas which had ascended through my cervix. My question is could the drop in progesterone have allowed my cervix to open and allow this infection through or would it have happened anyway? How long would this infection have taken to spread to the point where the placenta was coming away from the uterus lining?
I am now pregnant again at 12 weeks with a single baby and despite having been promised that I would be given progesterone this time, I am struggling to get it prescribed (I assume due to funding) My doctors say they do not believe my miscarriage was connected to my cervix being weak as it showed no sign of shortening (4.3cm)but is a weak cervix only about the length or could my LOOP excisions have weakened it in some other way? I didn't fight for the progesterone last time and have regretted it ever since as I am convinced it is connected. I don't want history to repeat itself which it feels like is happening. What is your view on progesterone to strengthen the cervix and how can I stop infections from getting through? I am having 4 weekly swabs taken. The first of these caused slight bleeding - pinky red blood on the swab - which makes me worry that there is a weakness there if it bleeds so easily.
Thank you for your time in responding to this.
The role of progesterone is to support the uterine lining in the 1st 12 weeks of pregnancy till the placenta is completely formed. Later than 12 weeks, progesterone is prescribed if there is a concern about preterm delivery for reasons other than cervical trauma or injury.
Preterm delivery is a risk in your case because of the 2 previous LOOP excisions. Ultrasound can precisely dtermine the status of the cervix in this situation. However, progesterone does not help to reduce the risk of preterm delivery after any cervical surgery.
I hope these info helps you.