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Archives of Gynecology and Obstetrics

, Volume 300, Issue 5, pp 1287–1293 | Cite as

The role of repeat misoprostol dose in the management of early pregnancy failure

  • Amihai RottenstreichEmail author
  • Gabriel Levin
  • Avi Ben Shushan
  • Simcha Yagel
  • Shay Porat
General Gynecology
  • 49 Downloads

Abstract

Purpose

We aimed to assess the role of repeat misoprostol administration in those with thickened endometrium in the management of early pregnancy failure (EPF).

Methods

A retrospective cohort study in two university hospitals among women receiving misoprostol treatment for EPF. Those with thickened endometrium at the first follow-up visit, who received a repeat 800 µg dose of vaginal misoprostol in institution B and no treatment in institution A, constituted the study group. The primary outcome was treatment success, defined as complete uterine evacuation without the need for any operative intervention

Results

Overall, 608 women with thickened endometrium as assessed by transvaginal ultrasonography 2 days following initial misoprostol administration for EPF were included. Of them, 427 did not receive repeat misoprostol dose, and 181 received repeat misoprostol dose. The rate of surgical intervention did not differ between those who received a repeat misoprostol dose (6.1%) and those who did not (4.3%) (P = 0.32). The median endometrial thickness was similar in those that did and did not require subsequent surgical intervention (P = 0.65), and was a poor predictor of treatment outcome.

Conclusions

Repeat misoprostol administration among women with thickened endometrium following initial misoprostol administration for EPF was not associated with improved treatment success rates.

Keywords

Misoprostol Early pregnancy failure Medical management Repeat dose Retained products of conception Thickened endometrium 

Abbreviations

ART

Assisted reproductive technologies

D&C

Dilatation and curettage

EPF

Early pregnancy

GA

Gestational age

MVA

Manual vacuum aspiration

Notes

Acknowledgements

We thank Ms. Sara Cohen for her editorial assistance.

Author contributions

AR: project development, data collection, data analysis, manuscript writing. GL and SY: manuscript writing/editing. SP: data collection and management, manuscript writing/editing. AB: project development and manuscript writing. All the authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have nothing to disclose and that they have no financial or non-financial conflict of interest.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the local institutional review board of Hadassah Medical Center Helsinki Committee (IRB Approval No. HMO 0157-18).

References

  1. 1.
    Wilcox AJ, Weinberg CR, O’Connor JF, Baird DD, Schlatterer JP, Canfield RE et al (1988) Incidence of early loss of pregnancy. N Engl J Med 319:189–194CrossRefGoogle Scholar
  2. 2.
    Wang X, Chen C, Wang L, Chen D, Guang W, French J (2003) Conception, early pregnancy loss, and time to clinical pregnancy: a population-based prospective study. Fertil Steril 79:577–584CrossRefGoogle Scholar
  3. 3.
    Zinaman MJ, Clegg ED, Brown CC, O’Connor J, Selevan SG (1996) Estimates of human fertility and pregnancy loss. Fertil Steril 65:503–509CrossRefGoogle Scholar
  4. 4.
    Alberman E (1992) Spontaneous abortions: epidemiology. In: Stabile I, Grudzinskas G, Chard T (eds) Spontaneous abortion: diagnosis and treatment. Springer- Verlag, London, pp 19–20Google Scholar
  5. 5.
    ACOG practice bulletin No. 200: Early Pregnancy Loss. Obstet Gynecol. 2018;Google Scholar
  6. 6.
    Neilson JP, Hickey M, Vazquez JC (2006) Medical treatment for early fetal death (less than 24 weeks). Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD002253.pub3 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Graziosi GC, Bruinse HW, Reuwer PJ, van Kessel PH, Westerweel PE, Mol BW (2005) Misoprostol versus curettage in women with early pregnancy failure: impact on women's health-related quality of life: a randomized controlled trial. Hum Reprod 20(8):2340–2347CrossRefGoogle Scholar
  8. 8.
    Graziosi GC, Bruinse HW, Reuwer PJ, Mol BW (2006) Women's preferences for misoprostol in case of early pregnancy failure. Eur J Obstet Gynecol Reprod Biol 124(2):184–186CrossRefGoogle Scholar
  9. 9.
    Zhang J, Gilles JM, Barnhart K, Creinin MD, Westhoff C, Frederick MM (2005) A comparison of medical management with misoprostol and surgical management for early pregnancy failure: National Institute of Child Health Human Development (NICHD) Management of Early Pregnancy Failure Trial. N Engl J Med 353:761–769CrossRefGoogle Scholar
  10. 10.
    Mizrachi Y, Dekalo A, Gluck O, Miremberg H, Dafna L, Feldstein O, Weiner E, Bar J, Sagiv R (2017) Single versus repeat doses of misoprostol for treatment of early pregnancy loss—a randomized clinical trial. Hum Reprod 32:1202–1207CrossRefGoogle Scholar
  11. 11.
    Doubilet PM, Benson CB, Bourne T et al (2013) Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 369:1443–1451CrossRefGoogle Scholar
  12. 12.
    CDC/NHSN surveillance definitions for specific types of infections. Available at: https://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf. Accessed 22 Dec 2018Google Scholar
  13. 13.
    Schreiber CA, Creinin MD, Atrio J, Sonalkar S, Ratcliffe SJ, Barnhart KT (2018) Mifepristone pretreatment for the medical management of early pregnancy loss. N Engl J Med 378(23):2161–2170CrossRefGoogle Scholar
  14. 14.
    Fernlund A, Jokubkiene L, Sladkevicius P, Valentin L (2018) Misoprostol treatment vs expectant management in women with early non-viable pregnancy and vaginal bleeding: a pragmatic randomized controlled trial. Ultrasound Obstet Gynecol 51(1):24–32CrossRefGoogle Scholar
  15. 15.
    Creinin MD, Harwood B, Guido RS, Fox MC, Zhang J (2004) Endometrial thickness after misoprostol use for early pregnancy failure. Int J Gynaecol Obstet 86(1):22–26CrossRefGoogle Scholar
  16. 16.
    Stockheim D, Machtinger R, Wiser A, Dulitzky M, Soriano D, Goldenberg M, Schiff E, Seidman DS (2006) A randomized prospective study of misoprostol or mifepristone followed by misoprostol when needed for the treatment of women with early pregnancy failure. Fertil Steril 86(4):956–960CrossRefGoogle Scholar
  17. 17.
    Bagratee JS, Khullar V, Regan L, Moodley J, Kagoro H (2004) A randomized controlled trial comparing medical and expectant management of first trimester miscarriage. Hum Reprod 19:266–271CrossRefGoogle Scholar
  18. 18.
    Luise C, Jermy K, May C, Costello G, Collins WP, Bourne T (2002) Outcome of expectant management of spontaneous first trimester miscarriage: observational study. BMJ 324:873–875CrossRefGoogle Scholar
  19. 19.
    Reeves MF, Lohr PA, Harwood BJ, Creinin MD (2008) Ultrasonographic endometrial thickness after medical and surgical management of early pregnancy failure. Obstet Gynecol 111:106–112CrossRefGoogle Scholar
  20. 20.
    Gronlund A, Gronlund L, Clevin L, Andersen B, Palmgren N, Lidegaard O (2002) Management of missed abortion: comparison of medical treatment with either mifepristone + misoprostol or misoprostol alone with surgical evacuation: A multi-center trial in Copenhagen County. Denmark. Acta Obstet Gynecol Scand. 81:1060–1065CrossRefGoogle Scholar
  21. 21.
    Ravn P, Rasmussen A, Knudsen UB, Kristiansen FV (2005) An outpatient regimen of combined oral mifepristone 400 mg and misoprostol 400 microg for first-trimester legal medical abortion. Acta Obstet Gynecol Scand 84(11):1098–1102PubMedGoogle Scholar
  22. 22.
    Creinin MD, Huang X, Westhoff C, Barnhart K, Gilles JM, Zhang J (2006) Factors related to successful misoprostol treatment for early pregnancy failure. Obstet Gynecol 107(4):901–907CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyHadassah-Hebrew University Medical CenterJerusalemIsrael

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