Predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding

Abstract

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.

Predicting the likelihood of successful medical treatment of early pregnancy loss: development and internal validation of a clinical prediction model

“…Apart from the use of mifepristone, and being a non-smoker, no significant clinical predictors of treatment success were found in their study (Sonalkar et al, 2020). Most recently, Fernlund et al (2020) investigated predictors of complete miscarriage after expectant or misoprostol treatment. No variable predicting success of misoprostol treatment was found.…”

“…Although some clinical predictors appear to predict treatment success of medical treatment of EPL, no prediction models exist to date (Schreiber et al, 2015;Fernlund et al, 2020;Sonalkar et al, 2020). With this study, we aimed to develop and internally validate a prediction model for successful medical treatment of EPL, after a minimum of 1 week of unsuccessful expectant management.…”

Early Pregnancy Fetal Cardiac Activity Detection by Superb Micro-Vascular Imaging (cSMI) Comparing with Color Doppler Ultrasound

“…7,8 In early pregnancy, the location and viability are key in establishing the diagnosis and guidelines for further management. 9 Miscarriage is a sensitive matter, and women who find the diagnosis difficult to accept do not appreciate fetal cardiac activity on the grey scale. Conventional Doppler should be advised with the case option.…”