4 Thursday November 25 2021 | the times
News
Pregnant women who have a higher
risk of a miscarriage should be treated
with a hormone that could lead to an
extra 8,000 births a year, the health
watchdog has said.
The National Institute for Health
and Care Excellence (Nice) has issued
an update to its guidance on miscar-
riage, saying that certain women can be
offered progesterone to help prevent
the loss of pregnancies.
Tommy’s, the charity that conducted
research into the drug’s benefits, said
that the move would “help save babies’
lives and spare parents heartache”.
The more miscarriages a woman had
the more effective progesterone was,
the research found. The naturally oc-
curring hormone helps to prepare the
womb for carrying a foetus.
Nice said that women who had previ-
ously had a miscarriage, had had a
pregnancy confirmed by a scan and
who were bleeding could be offered the
drug twice daily. It estimates that about
7,200 women could be eligible for treat-
ment each year, though Tommy’s said
the move could prevent as many as
8,450 miscarriages a year.
Nice’s independent guidelines com-
mittee said that the hormone should
not be offered to women with early
pregnancy bleeding but no previous
miscarriage, nor to women with a pre-
vious miscarriage but no early bleeding
in the current pregnancy. It has called
for more research in these two areas.
Nice said there was no evidence ofharm to the mother or baby from the
use of progesterone, although the evi-
dence was insufficient to rule out the
possibility of rare events.
Jane Brewin, Tommy’s chief execu-
tive, said: “It’s great to see Nice taking
our progesterone research on board inAsking people to travel about 40 miles
for routine NHS care will help dis-
charge the “moral obligation” to bring
down waiting lists, health chiefs argue.
Patient leaders are open to plans to
bring down waiting lists that stand at
5.8 million, but insisted last night that
NHS is morally obliged to cut waiting list, bosses say
the changes must not make it harder to
see a GP or worsen health inequalities.
The Times revealed yesterday that a
radical NHS plan for dealing with the
post-pandemic backlog recommends
scrapping routine follow-up appoint-
ments and introducing “clearing
houses” to offer treatment in other
cities. Amanda Pritchard, chief execu-tive of NHS England, said it was a prior-
ity “to get people treated as quickly as
we possibly can”, and promised the
“multiyear plan to address this” would
be published in the coming days.
Chris Hopson, chief executive of the
hospitals’ group NHS Providers, said
the health service had a “moral obliga-
tion” to clear backlogs. He cited a trial ofsending people from Bath and Swindon
to Salisbury, about 40 miles away.
Charlotte Augst, of the patient group
National Voices, said: “If we reduce at-
tendances for follow-ups, do we just
shift the need for people to talk about
ongoing symptoms to primary care? A
narrow focus on one pressure point
risks creating more problems.”Chris Smyth Whitehall Editor
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A farmer, an England footballer
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Cryptic clues Page 10 of TimesHormone treatment could stop
over 8,000 miscarriages a year
their new miscarriage care guidelines,
which will help save babies’ lives and
spare parents heartache. Miscarriage is
often dismissed as ‘one of those things’
we can’t do anything about, even by
some healthcare professionals, who
may not specialise in this area to know
the latest evidence.
“We hear from women who were de-
nied progesterone treatment when
they should have been eligible, simply
because their doctor wasn’t familiar
with it, so we hope Nice’s recommend-
ation will help end some of these in-
equalities in miscarriage care.”
Professor Arri Coomarasamy, direct-
or of Tommy’s National Centre for Mis-
carriage Research at the University of
Birmingham, said: “The miscarriage
care guidelines from Nice include a
very welcome change, after many years
researching the use of progesterone
and working to make treatment more
accessible. Our research has shown
that progesterone is a robust and
effective treatment option but we know
it’s not yet reaching everyone who
might benefit.
“This new recommendation from
Nice is an important step in tackling the
current variation in miscarriage ser-
vices across the country and preventing
these losses wherever possible.”Peter Chappell
Q&A
What is progesterone?
It is a natural female sex
hormone. Levels rise
and fall during the
menstrual cycle. During
pregnancy it helps to
grow the lining of the
womb, and helps the
mother’s body to accept
the foetus.How can it be used in
pregnancy?
Women who experience
bleeding during early
pregnancy and have
had at least one
miscarriage should begiven progesterone to
take twice daily,
according to Nice (the
National Institute for
Health and Care
Excellence). The drug is
taken as tablets placed
in the vagina, until 16
completed weeks of
pregnancy.What has research
found?
Two studies reported
last year. The Promise
study, which involved
836 women with
unexplained recurrent
miscarriages in the UK
and the Netherlands,
found a 3 per cent
higher live birth rate
with progesterone.The Prism study
involved 4,153 women
with early pregnancy
bleeding in the UK, and
found a 5 per cent
increase in the number
of babies born to
women who had had
one or more
miscarriages compared
with those given a
placebo.How common is
bleeding in pregnancy?
About 20 per cent of
pregnant women
experience bleeding
before 12 weeks.
It is not always a sign of
a problem, but does
increase the risk of
miscarriage.Gripping moments Rob Lovell clings on above the Atlantic at Cape Wrath in Scotland, the most north-westerly point of mainland Britain. The image of his determination
in action has been shortlisted in the Red Bull Illume photography competition which captures extreme sports, from mountain biking to kayaking, in all their daring glory
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