May 5 2020
What was the PRISM trial?
The PRISM trial was the largest ever randomised trial in miscarriage prevention. Researchers at the Tommy’s National Centre for Miscarriage Research recruited more than 4000 women from 48 hospitals in the UK. The study evaluated the effects of giving progesterone to women with early pregnancy bleeding.
What were the findings of the PRISM trial?
Overall, there was a 3% increase in the live birth rate for the group of women who received progesterone, compared with a placebo, but the finding was associated with some statistical uncertainty. However, a clear benefit was found for women who were experiencing early pregnancy bleeding and a history of (any number of) previous miscarriages. The higher the number of previous miscarriages, the greater the live birth rate, with progesterone treatment.
For women who had 1 or 2 previous miscarriages, and had current pregnancy bleeding, progesterone was associated with a 4% increase in live births. For women with 3 or more previous miscarriages, and had current pregnancy bleeding, progesterone was associated with a 15% increase in live births.
How will this impact clinical practice?
Tommy’s researchers have now recommended that progesterone treatment should be considered for women with early pregnancy bleeding and a history of any number of previous miscarriages. The recommended regimen is 400mg progesterone pessary to be used twice daily from the time of presentation with bleeding to 16 weeks of gestation.
"I experienced 3 heart-breaking miscarriages before the PRISM trial. My husband and I had got to the point where we were devastated and lost. The trial helped us to feel we were doing something positive and gave us hope that the outcome could be different. The personal impact of miscarriage can be long term and far reaching. It’s clear that providing progesterone to those at risk would not only have significant benefits for women and their families, but also for the NHS."
Faye took part in the PRISM trial in 2016 after experiencing recurrent miscarriage.
PRISM trial funding
The PRISM trial was funded by the NIHR-HTA programme and supported by the Tommy's National Centre for Miscarriage Research. The trial was led from the Institute of Metabolism and Systems Research at the University of Birmingham, facilitated by the Birmingham Clinical Trials Unit.Hide details
Tommy’s has received a grant from the UK Government’s Department for Health and Social Care to support the costs of its PregnancyHub information and support services throughout the summer, due to rising demand in the wake of coronavirus.
Although recruitment to some clinical trials had to be paused when coronavirus hit the UK, scientists at Tommy’s Research Centres across the UK are still hard at work, supporting women and families in our specialist clinics and sharing their latest studies with academic journals.
The day before Mother’s Day, and two days before the UK officially went into coronavirus lockdown, Zara Dawson found out she was having a miscarriage. Her third consecutive miscarriage in less than a year, and fourth consecutive loss, after losing her second son Jesse in 2018 to termination for medical reasons.
As research shows half of UK mums are experiencing mental health problems in coronavirus lockdown, we've joined forces with Elvie on #TheBigSqueeze campaign to help Tommy's midwives continue to provide their vital support virtually during the pandemic.