Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location

Goldberg, Alisa B.; Fulcher, Isabel R.; Fortin, Jennifer; Hofer, Rebecca K; Cottrill, Alex; Dethier, Divya; Gilbert, Allison L.; Janiak, Elizabeth; Roncari, Danielle

doi:10.1097/aog.0000000000004756

Cited by 21 publications

(16 citation statements)

References 17 publications

(27 reference statements)

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“…We agree with Goldberg et al that the most serious risk of initiating medication abortion for pregnancy of unknown location is delayed diagnosis and treatment of ectopic pregnancy. 1 However, significant flaws preclude the authors' conclusions and do not support the safety of immediate mifepristone in pregnancy of unknown location.…”

mentioning

confidence: 91%

Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location

Cirucci¹,

Harrison²,

Francis³

2022

Obstetrics &Amp; Gynecology

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mentioning

confidence: 91%

Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location

Cirucci¹,

Harrison²,

Francis³

2022

Obstetrics &Amp; Gynecology

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“…We commend Parker et al's original work 1 and appreciate the opportunity to respond to the Letter from him and his colleagues. In addressing the main critique, van der Schouw et al 2 studied only timing and cause of menopause and did not assess those who had oophorectomy after they had undergone menopause for any other reason.…”

mentioning

confidence: 94%

“…leading them to conclude that delaying oophorectomy to age 65 years had benefits. 1 Although van der Schouw et al did…”

mentioning

confidence: 99%

A Revised Markov Model Evaluating Oophorectomy at the Time of Hysterectomy for Benign Indication: Age 65 Years Revisited

Parker

Broder

Berek

et al. 2022

Obstetrics &Amp; Gynecology

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“…There is also evidence that commencing medical abortion in very early pregnancy (ie, before ultrasound visualisation of probable IUP) is safe and effective when undertaken alongside a robust protocol with close monitoring of serum-hCG levels for a satisfactory percentage decline at day 8 of abortion compared with baseline (day 1) 8–10. A systematic review conducted as part of the 2019 National Institute of Health and Care Excellence (NICE) guidelines on abortion care concluded that commencing abortion before ultrasound evidence of IUP was not associated with a significantly higher rate of missed ectopic pregnancy diagnoses 11…”

Section: Introductionmentioning

confidence: 99%

Very early medical abortion: treatment with mifepristone and misoprostol before ultrasonographic visualisation of an intrauterine pregnancy

Tai

Reynolds-Wright

Cameron

2022

BMJ Sex Reprod Health

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IntroductionAbortion providers may be reluctant to commence abortion before ultrasound evidence of intrauterine pregnancy (IUP) due to concerns of missed ectopic pregnancy. In 2017, very early medical abortion (VEMA) was introduced at an abortion service in Edinburgh, UK. Following ultrasound, patients without confirmed IUP, and without symptoms or risk factors for ectopic pregnancy, could commence treatment immediately after baseline serum-human chorionic gonadotrophin (hCG) measurement, and return for follow-up serum-hCG a week later to determine treatment success (≥80% decline from baseline). This study aimed to compare clinical outcomes between two pathways: (1) VEMA; and (2) standard-of-care delayed treatment where treatment is only commenced on IUP confirmation by serial serum-hCG monitoring and/or repeat ultrasound.MethodsA retrospective database review was conducted of VEMA eligible patients from July 2017 to December 2021. Study groups were determined by patient preference. Records were searched for abortion outcomes, duration of care, number of appointments (clinic visits, ultrasounds, serum-hCG) and clinical data entries.ResultsOf 181 patients included, 77 (43%) chose VEMA and 104 (57%) chose delayed treatment. 11/181 (6.1%) were lost to follow-up. Cohort ectopic prevalence was 4.4% and was not statistically different between groups (2.6% vs 5.8%, VEMA vs delayed group, respectively, p=0.305), as with complete abortion rates (93.3% vs 97.6%, p=0.256). All VEMA group ectopics were detected on the seventh day (from initial visit) while time-to-diagnosis for delayed group ectopics ranged from 7 days to 3 weeks. VEMA patients had significantly reduced duration of care (12 vs 21 days, p<0.001), number of visits (2 vs 3, p<0.001), ultrasounds (1 vs 2, p<0.001) and data entries (6 vs 9, p<0.001).ConclusionsVEMA is safe, effective and reduces the duration of care, number of appointments and clinical administrative time. It should be offered to medically eligible patients.

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Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location

Abstract: For undesired pregnancy of unknown location, immediate abortion initiation with mifepristone and misoprostol is associated with more rapid exclusion of ectopic pregnancy and pregnancy termination but lower abortion efficacy than delaying for diagnosis.

Cited by 21 publications

References 17 publications

Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location

Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location

A Revised Markov Model Evaluating Oophorectomy at the Time of Hysterectomy for Benign Indication: Age 65 Years Revisited

Very early medical abortion: treatment with mifepristone and misoprostol before ultrasonographic visualisation of an intrauterine pregnancy

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