This study aimed to evaluate clinical predictors associated with complete miscarriage after medical treatment for early pregnancy loss (EPL) in women with previous cesarean section. Patients with retained uterine content after expulsion followed by administration of mifepristone and misoprostol were included if they chose continued medical treatment rather than surgical intervention. Clinical characteristics including maternal age, gravidity, parity, history of previous cesarean section and ultrasound findings regarding average diameter of the gestational sac, uterine position, width, and blood flow signal of the residual uterine content after expulsion of the gestational sac were included in the analysis to determine predictors of complete miscarriage. A recursive partitioning analysis (RPA) was used to divide the patients into probability groups and assess their probability of complete miscarriage. A total of 89 patients were analyzed. The complete miscarriage rate was 58.43% overall. Multivariable logistic regression analysis showed that the width and blood flow signal of the residual after expulsion were both independent predictors for complete miscarriage (all P < .05). Patients were divided into high-probability (no blood flow signal, width of residual <1 cm), intermediate-probability (no blood flow signal, width of residual ≥1 cm; blood flow signal, width of residual <1 cm), and low-probability (blood flow signal, width of residual ≥ 1 cm) groups by RPA according to these 2 factors. The incidences of complete miscarriage were 88.24%, 67.57%, and 34.29%, respectively, P < .001). Surgical evacuation may be avoided in patients without ultrasonic blood flow of the uterine residual and width of the residual <1 cm. More active treatment could be recommended for patients with ultrasonic blood flow of the uterine residual and width of the residual ≥ 1 cm. Clinicians and patients should be aware of these differences when proceeding with medical treatment for EPL patients with previous cesarean section.
To analyze the efficacy and influencing factors of Mifepristone combined with estrogen-progesterone sequential therapy (Femoston) in the treatment of incomplete abortion. This retrospective cohort study included 93 patients with incomplete abortion. All patients took 50 mg of Mifepristone 2 times a day for 5 days and then took Femoston once a day (starting with estradiol tablets/2 mg) for 28 days. Without any indication of intrauterine residue by ultrasonic examination was judged to be effective. According to statistical analysis, this study calculated the effective rate and analyzed its influencing factors. A 2-sided value of P < .05 was considered statistically significant. The total response rate of the treatment regimen was 86.67%. body mass index was a significant influencing factor for treatment outcome (OR 0.818, 95% confidence interval 0.668–0.991, P = .041). For patients with incomplete abortion, Mifepristone combined with estrogen-progesterone sequential therapy has a remarkable therapeutic effect. Patients with a lower body mass index may respond much more significantly to this treatment regimen.
Objective To investigate the efficacy of weekly changes in β-human chorionic gonadotropin (β-hCG), estradiol (E2), and progesterone (Prog) levels for pregnancy assessment in patients with unexplained recurrent miscarriage. Methods We included 140 patients with unexplained recurrent miscarriage whose serum β-hCG, E2, and Prog levels were measured three or more times within early pregnancy. The weekly change in serum β-hCG, E2, and Prog levels (Δβ-hCG, ΔE2, and ΔProg) was calculated according to the following formula: [(serum level at third visit) - (serum level at initial visit)]/interval days×7. Participants were divided into two groups according to pregnancy outcomes, which were determined as ongoing pregnancy or miscarriage, at the 20th week of gestation. The Δβ-hCG, ΔE2, and ΔProg levels of the two groups were compared, and the cutoff values of Δβ-hCG, ΔE2, and ΔProg were determined using receiver operating characteristic (ROC) analyses for predicting pregnancy outcome. Results Serum levels of Δβ-hCG identified ongoing pregnancy or miscarriage with an area under the ROC curve (AUC) of 0.841 (95% CI 0.769–0.914), diagnostic cutoff value of 30,632.855 mIU/ml, sensitivity of 0.971, and specificity of 0.642. ΔE2 levels had an AUC of 0.839 (95% CI 0.752–0.926), cutoff value of 45.055 pg/ml, sensitivity of 0.706, and specificity of 0.915. Conclusion Higher increases in the serum levels of Δβ-hCG and ΔE2 are associated with favorable pregnancy outcomes. Weekly remeasurement of serum β-hCG and E2 may be useful for pregnancy risk assessment in patients with unexplained recurrent miscarriage throughout clinical practice.
Purpose To investigate the clinical value of hysteroscopy with chromopertubation (HSC) in infertile patients with hysterosalpingography (HSG) evidence of abnormal tubal patency. Methods The study consisted of 296 patients. HSG was performed as a preliminary test for the evaluation of fallopian tube status. Patients who desired to conceive naturally were treated with HSC in the next month or followed-up without additional treatment. The primary outcome was natural clinical pregnancy within 12 months after the procedure. Results In total, the number of clinical pregnancies was estimated to be 70 of 143 (48.95%) clinical pregnancies with management by HSC and 65 of 153 (42.48%) pregnancies with management comprising follow-up without additional treatment, and this was not significantly different (Log rank test, P = 0.516). Subgroup analysis showed that among women with bilateral abnormalities by HSG, patients receiving management with HSC tended to have a higher probability of pregnancy throughout the follow-up period than women without HSG (Log rank test, P = 0.005). No corresponding significant difference was found for women with a unilateral abnormality (P = 0.674). Conclusion HSC shows potential fertility improvement value for infertile patients with tubal factors. HSC may be complementary to HSG and could be incorporated as a modality of the fertility work-up.
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