Abstract
Research question
Does extending the follow-up after misoprostol treatment for early pregnancy loss
increase the success rate?
Design
Patients who had experienced early pregnancy loss (<12 weeks) and were treated with
misoprostol in a single university-affiliated medical centre were prospectively followed
before and after the implementation of a new treatment protocol extending the follow-up
from 1 to 2 weeks. All patients received misoprostol 800 μg vaginally on day 1 and
a second dose, when needed, on day 4 or 8. Patients underwent surgical aspiration
after 1 week in the early follow-up group (n = 84) or 2 weeks in the delayed follow-up group (n = 85) if complete expulsion was not achieved (defined as endometrial thickness ≤15
mm and absence of gestational sac on transvaginal sonography). The primary outcome
was treatment success, defined as no need for surgical aspiration.
Results
Women in the delayed follow-up group had a higher rate of successful treatment compared
with women in the early follow-up group (88.2% versus 76.2%, respectively; P = 0.040), and a lower rate of second dose administration (32.9% versus 51.2%, respectively;
P = 0.016). The incidence of non-expulsion of the gestational sac was also lower in
the delayed follow-up group (1.2% versus 10.7%; P = 0.009). Treatment acceptability did not differ between the study groups.
Conclusion
In women with early pregnancy loss treated with misoprostol, extending the follow-up
protocol from 1 to 2 weeks resulted in an increase in treatment success.
KEYWORDS
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Reproductive BioMedicine OnlineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Acog committee opinion no. 427: Misoprostol for postabortion care.Obstet Gynecol. 2009; 113: 465-468
- Practice bulletin no. 200: Early pregnancy loss.Obstetrics and gynecology. 2018;
- An effective regimen for early medical abortion: A report of 2000 consecutive cases.Human reproduction (Oxford, England). 1998; 13: 2962-2965
- Medical management of non-viable early first trimester pregnancy.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 1999; 67: 9-13
- The management of missed miscarriage in an outpatient setting: 800 versus 600 mug of vaginal misoprostol.The Australian & New Zealand journal of obstetrics & gynaecology. 2012; 52: 39-43
- Marked improvement in the success rate of medical management of early pregnancy failure following the implementation of a novel institutional protocol and treatment guidelines: A follow-up study.Archives of gynecology and obstetrics. 2016; 294: 1265-1272
- Endometrial thickness after misoprostol use for early pregnancy failure.Int J Gynaecol Obstet. 2004; 86: 22-26
- Diagnostic criteria for nonviable pregnancy early in the first trimester.The New England journal of medicine. 2013; 369: 1443-1451
- Single versus repeat doses of misoprostol for treatment of early pregnancy loss-a randomized clinical trial.Human reproduction (Oxford, England). 2017; 32: 1202-1207
- Medical treatment for early fetal death (less than 24 weeks).The Cochrane database of systematic reviews. 2006; (Cd002253)
- Vaginal misoprostol as medical treatment for first trimester spontaneous miscarriage.Human reproduction (Oxford, England). 2001; 16: 1493-1496
- Medical abortion outcomes after a second dose of misoprostol for persistent gestational sac.Contraception. 2008; 78: 332-335
- Mifepristone pretreatment for the medical management of early pregnancy loss.The New England journal of medicine. 2018; 378: 2161-2170
- Early pregnancy termination with mifepristone and misoprostol in the united states.The New England journal of medicine. 1998; 338: 1241-1247
- The added value of mifepristone to non-surgical treatment regimens for uterine evacuation in case of early pregnancy failure: A systematic review of the literature.European journal of obstetrics, gynecology, and reproductive biology. 2015; 195: 18-26
- Conception, early pregnancy loss, and time to clinical pregnancy: A population-based prospective study.Fertility and sterility. 2003; 79: 577-584
- Ultrasonography may have role in assessing spontaneous miscarriage.Bmj. 2001; 323: 694
- Incidence of early loss of pregnancy.N Engl J Med. 1988; 319: 189-194
- Misoprostol for medical treatment of missed abortion: A systematic review and network meta-analysis.Scientific reports. 2017; 7: 1664
- Estimates of human fertility and pregnancy loss.Fertility and sterility. 1996; 65: 503-509
Biography
Yossi Mizrachi is a resident in obstetrics and gynaecology at the Edith Wolfson Medical Center, affiliated with Tel-Aviv University, Israel. His main research interests are reproductive medicine and early pregnancy loss.Key message
Extending the follow-up protocol after misoprostol treatment for early pregnancy loss from 1 to 2 weeks resulted in higher success rates and reduced the need to administer a second dose. Patients and clinicians can be reassured that a delay in follow-up maximizes the chance of complete expulsion.
Article info
Publication history
Published online: March 11, 2019
Accepted:
February 25,
2019
Received in revised form:
January 15,
2019
Received:
November 18,
2018
Declaration The authors report no financial or commercial conflicts of interest.Identification
Copyright
© 2019 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
