ABSTRACT

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Purpose To identify predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding. Methods This was a planned secondary analysis of data from a published randomized controlled trial comparing expectant management with vaginal single dose of 800 µg misoprostol treatment of women with embryonic or anembryonic miscarriage. Predefined variables—serum-progesterone, serum-β-human chorionic gonadotropin, parity, previous vaginal deliveries, gestational age, clinical symptoms (bleeding and pain), mean diameter and shape of the gestational sac, crown-rump-length, type of miscarriage, and presence of blood flow in the intervillous space—were tested as predictors of treatment success (no gestational sac in the uterine cavity and maximum anterior–posterior intracavitary diameter was ≤ 15 mm as measured with transvaginal ultrasound on a sagittal view) in univariable and multivariable logistic regression. Results Variables from 174 women (83 expectant management versus 91 misoprostol) were analyzed for prediction of complete miscarriage at ≤ 17 days. In patients managed expectantly, the rate of complete miscarriage was 62.7% (32/51) in embryonic miscarriages versus 37.5% (12/32) in anembryonic miscarriages (P = 0.02). In multivariable logistic regression, the likelihood of success increased with increasing gestational age, increasing crown-rump-length and decreasing gestational sac diameter. Misoprostol treatment was successful in 80.0% (73/91). No variable predicted success of misoprostol treatment. Conclusions Complete miscarriage after expectant management is significantly more likely in embryonic miscarriage than in anembryonic miscarriage. Gestational age, crown-rump-length, and gestational sac diameter are independent predictors of success of expectant management. Predictors of treatment success may help counselling women with early miscarriage.

What are the novel findings of this work?Reproductive outcome after early embryonic or anembryonic miscarriage does not differ between women treated with vaginal misoprostol and those managed expectantly, with 75% of women in each group achieving at least one new pregnancy within 14 months after the miscarriage and 40% and 35%, respectively, having at least one live birth within the same period. What are the clinical implications of this work?Women with early miscarriage can be counseled that treatment with misoprostol or expectant management is similar with respect to future fertility.

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sampling frame moved from the cervix to the fundus in the sagittal plane. The longitudinal distance was measured between the start point and the end point of placental implantation destroying lesion, then the transverse diameter was measured on the axial plane. The location, area and depth of placental implantation were estimated. The morphological changes of double track sign can be divided into four types: type A-complete double track sign, type B-point monorail type, type C-linear monorail type and type D-trackless type. The scores from AD are 1-4. Results: Among 37 cases, there were 30 cases of type A, 12 cases of type B, 28 cases of type C, and 17 cases of type D trackless, including 8 cases of placenta implantation penetrating the serous layer to the wall of the bladder or broad ligament, 6 cases of uterine perforation and 7 cases of cervical implantation. There were totally 14 different pathomorphic combinations of varying degrees of placental implantation. The average score of was 7.96 ± 2.78 (1-13), and the average bleeding volume was 1050 ± 1616ml (300-5000ml). When total score was over 7 points, and the amount of bleeding volume increased by 1445 ± 1045ml (800-5000ml), which was a significant difference. Conclusions: Three dimension Crystal Vue imaging can realise accurate assessment of the site, depth and scope of placental invasion as well as the intraoperative bleeding volume, which provides accurate imaging basis for clinicians to develop personalised medical treatments.