Association between uterine position and transvaginal misoprostol treatment for early pregnancy failure

Chill, Henry H.; Malyanker, Nirit; Karavani, Gilad; Haj-Yahya, Rani; Herzberg, Shmuel; Bahar, Raz; Shveiky, David; Dior, Uri

doi:10.1111/jog.13512

Cited by 6 publications

(8 citation statements)

References 20 publications

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“…Higher may also serve as negative predictive factor for treatment success, according to additional studies (4,6,12). In agreement with our study, Chill and Vejborg (13,14) both independently reported an inverse correlation between ultrasound-calculated GA and success rate.…”

Section: Discussionsupporting

confidence: 93%

Medical Treatment for Earl Pregnancy Loss Following In Vitro Fertilization Compared to Spontaneous Pregnancies: a Retrospective Study

Gluck

Barber

Feldstein

et al. 2022

Preprint

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Background: Misoprostol is a well-studied medical treatment for early pregnancy loss (EPL), with success rates ranging between 70-90%. However, treatment failure is associated with major patient discomfort, including the need for surgical intervention to evacuate the uterus. It was reported that medical treatment was especially successful among women who conceived after in vitro fertilization (IVF). We aimed to study if there is a difference in rates of medical treatment failures for EPL between pregnancies conceived by IVF and spontaneous pregnancies. This is a retrospective cohort study. Methods: All women who underwent medical treatment for EPL at our institute between 07/2015 and 12/2020 were included. The cohort was divided into two groups: IVF and spontaneous pregnancies.Treatment failure was defined as any surgical intervention, namely, dilation & curettage (D&C) and/or hysteroscopy, due to retained products of gestation. Baseline characteristics and failure rates were compared between the groups.Results: Overall, 775 patients were included, of which 195 (25.1%) ultimately required surgical intervention. There was no difference between the groups in the rate of treatment failure. However, among the IVF group, the rate of emergency D&C was lower (3.6% vs. 9.8%, p=0.001) compared to the spontaneous group. Conclusion: In cases of medical treatment for EPL, IVF pregnancies have lower chances to undergo emergency D&C, compared to spontaneous pregnancies. Overall, there are no differences in rates of treatment failure between IVF and spontaneous pregnancies.

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Section: Discussionsupporting

confidence: 93%

Medical Treatment for Earl Pregnancy Loss Following In Vitro Fertilization Compared to Spontaneous Pregnancies: a Retrospective Study

Gluck

Barber

Feldstein

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…On the other hand, Odeh et al 4 reported no correlation between gestational sac volume (according to three‐dimensional ultrasound) and success rate. According to the first two, 6 , 7 the current study strengthens the hypothesis that the larger the pregnancy, the greater the risk of undergoing additional surgical intervention.…”

Section: Discussionsupporting

confidence: 80%

“…The association between ultrasound findings and success rates of medical treatment for EPL was studied previously: Chill et al 7 compared 195 patients who had successful treatment with 51 patients with treatment failure and reported that in the success group, the average embryonic sac was shorter than in the failure group. Similarly, Lusink et al 6 studied 336 patients and suggested that a smaller gestational sac diameter predicts successful medical treatment.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 , 4 Several predicting factors for misoprostol treatment failure were reported, including primigravidity, assisted reproductive technology (ART), serum biomarkers, and vaginal bleeding before treatment. 2 , 4 , 5 The correlation between gestation size (GS) and failure rates is controversial: two studies reported a negative association, 6 , 7 but a third study failed to demonstrate this association. 4 It ought to be pointed out that these studies were of relatively small sample sizes.…”

Section: Introductionmentioning

confidence: 99%

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Surgical intervention after medical treatment for early pregnancy loss according to gestational size

Gluck

Barber

Tal

et al. 2022

Intl J Gynecology & Obste

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Objective To study the rate of surgical intervention for unsuccessful medical treatment in early pregnancy loss (EPL), according to gestational size by ultrasound (GS‐US). Methods This was a retrospective cohort study. All women who were treated with misoprostol for EPL between July 2015 and December 2020 were included. The cohort was divided according to GS‐US: group 1: gestational sac without an embryonic pole; group 2: an embryonic pole with crown‐rump length (CRL) compatible with <7 weeks; group 3: CRL compatible with 7+0–7+6 weeks; group 4: CRL compatible with 8+0–8+6 weeks; group 5: CRL compatible with ≥9 weeks. We compared the rate of any surgical intervention due to treatment failure. Results Overall, 783 patients were included: group 1, 236 (30.1%); group 2, 319 (40.7%); group 3, 115 (14.7%); group 4, 78 (10.0%); and group 5, 35 (5.0%) patients. The rate of any surgical intervention was significantly lower in groups 1–4 (54, 22.9%; 85, 26.6%; 28, 24.3%; and 22, 28.2%, respectively) compared with group 5 (17, 48.6%; P = 0.030). On multivariant analysis, GS‐US greater than 9 weeks was independently associated with the need for surgical intervention (adjusted odds ratio 1.23, 95% confidence interval 1.01–1.51; P = 0.040). Conclusion When treating EPL medically, GS‐US greater than 9 weeks increases the risk of undergoing additional surgical intervention compared with younger weeks.

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“…The most common medical treatment for first trimester miscarriages is misoprostol [7]. Administered vaginally, it offers success rates ranging from 70% to 90% [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Failure Rate of Medical Treatment for Miscarriage Correlated with the Difference between Gestational Age According to Last Menstrual Period and Gestational Size Calculated via Ultrasound

Gluck,

Barber,

Friedman

et al. 2023

JCM

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Objective: To study whether the interval between gestational age calculated using the last menstrual period (GA-LMP) and gestational age calculated via ultrasound (GA-US) is correlated with the success rate of medical treatment in cases of miscarriages. Methods: This was a retrospective cohort study conducted in a gynecology unit in a tertiary medical center. Women who underwent medical treatment with Misoprostol for miscarriage at the Edith Wolfson Medical Center between 07/2015 and 12/2020 were included. Incomplete or septic miscarriages, multiple pregnancies, patients with irregular periods, and cases of missing data were excluded. Failure of medical treatment was defined as the need for surgical intervention due to a retained gestational sac, severe bleeding or retained products of conception. The cohort study was divided into two groups: patients with successful treatment and patients for whom surgical intervention was eventually needed. We performed both a univariate and multivariate analysis in order to identify whether a correlation between GA-LMP and GA-US interval is indeed a factor in the success rate of a medical abortion. Results: Overall, 778 patients were included in the study. From this cohort 582 (74.9%) had undergone a successful medical treatment, while 196 (25.1%) required surgical intervention due to the failure of medical treatment, as defined above. The GA-LMP to GA-US interval (in weeks) was 2.6 ± 1.4 in the success group, while the GA in the failure group was 3.1 ± 1.6 (p < 0.001). After performing a multivariant regression analysis, we were able to show that the GA-LMP to GA-US interval was found to be independently correlated with an increase in the treatment failure rate (aOR = 1.24, CI 95% (1.01–1.51), p = 0.03). Conclusions: In cases of miscarriage, longer GA-LMP to GA-US interval has been shown to be an independently correlated factor to lower success rate of the medical treatment option.

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Association between uterine position and transvaginal misoprostol treatment for early pregnancy failure

Abstract: Uterine position has no effect on success rate of misoprostol treatment for EPF.

Cited by 6 publications

References 20 publications

Medical Treatment for Earl Pregnancy Loss Following In Vitro Fertilization Compared to Spontaneous Pregnancies: a Retrospective Study

Medical Treatment for Earl Pregnancy Loss Following In Vitro Fertilization Compared to Spontaneous Pregnancies: a Retrospective Study

Surgical intervention after medical treatment for early pregnancy loss according to gestational size

Failure Rate of Medical Treatment for Miscarriage Correlated with the Difference between Gestational Age According to Last Menstrual Period and Gestational Size Calculated via Ultrasound

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