Medical management of miscarriage: Predictive factors of success

Lusink, Vanessa; Wong, Clare; Vries, Bradley de; Ludlow, J.

doi:10.1111/ajo.12808

Cited by 6 publications

(7 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our predictive model confirmed that previous delivery by cesarean section and the higher anteroposterior diameter of uterine content were significant predictors for incomplete miscarriage at 1 week. Endometrial thickness has been proven in many studies as a significant predictor for incomplete miscarriage [25][26][27] and we agree with them. We speculate that vaginal delivery may facilitate the expulsion of the uterine contents.…”

Section: R E T R a C T E Dsupporting

confidence: 89%

Retracted: Misoprostol versus expectant management in women with incomplete first‐trimester miscarriage after failed primary misoprostol treatment: A randomized clinical trial

Ali

Emam

Abdel-Aleem

et al. 2021

Intl J Gynecology & Obste

View full text Add to dashboard Cite

Objective To compare the effectiveness and safety of repeat misoprostol versus expectant management in women with first‐trimester incomplete miscarriage who have been initially treated with misoprostol. Methods The study was an open‐labeled randomized controlled trial including women with an incomplete first‐trimester miscarriage after administration of misoprostol. The participants were randomly assigned to vaginal misoprostol or expectant management using a computer‐generated table of random numbers. The primary outcome was the number of women with a complete miscarriage at 1 week. Results Eighty‐eight women (44 women in each group) were analyzed. The rate of complete miscarriage at 1 week was significantly higher in the misoprostol group than the expectant management group—29 (69.0%) versus 7 (16.7%) (P < 0.001), respectively. Women in the misoprostol group were more satisfied (7.00 ± 0.77 vs 4.57 ± 1.61, P < 0.001) but reported more pain (7.95 ± 1.85 vs 5.26 ± 1.08, P < 0.001) than women in the expectant group. The misoprostol group reported more adverse effects than the expectant management group (P < 0.001). Conclusion In women with an incomplete first‐trimester miscarriage who were initially treated with misoprostol, repeat administration of misoprostol was more effective than expectant management for achieving complete miscarriage at 1 week. However, misoprostol was associated with more adverse effects. Registration site and number Clinicaltrials.gov: NCT03148561.

show abstract

Section: R E T R a C T E Dsupporting

confidence: 89%

Retracted: Misoprostol versus expectant management in women with incomplete first‐trimester miscarriage after failed primary misoprostol treatment: A randomized clinical trial

Ali

Emam

Abdel-Aleem

et al. 2021

Intl J Gynecology & Obste

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. On the other hand, Odeh et al 4 reported no correlation between gestational sac volume (according to three‐dimensional ultrasound) and success rate.…”

Section: Discussionmentioning

confidence: 98%

“… 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%

See 1 more Smart Citation

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

Gluck

Barber

Tal

et al. 2022

Intl J Gynecology & Obste

View full text Add to dashboard Cite

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.

show abstract

“…The combined mifepristone-misoprostol regimen has become the preferred treatment for EPL (Early Pregnancy Loss) of many practitioners, as it was shown to be superior to the misoprostol-only regimen. Several studies conducted over time have shown greater success rate in passing the gestational sac and lower rates in the need for a surgical intervention to complete the miscarriage [8,[23][24][25][26][27][28][29]. It is worth noting that no difference was found in the adverse events between the two groups.…”

Section: Discussionmentioning

confidence: 94%

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

View full text Add to dashboard Cite

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.

show abstract

Medical management of miscarriage: Predictive factors of success

Cited by 6 publications

References 11 publications

Retracted: Misoprostol versus expectant management in women with incomplete first‐trimester miscarriage after failed primary misoprostol treatment: A randomized clinical trial

Retracted: Misoprostol versus expectant management in women with incomplete first‐trimester miscarriage after failed primary misoprostol treatment: A randomized clinical trial

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

Contact Info

Product

Resources

About