The role of repeat misoprostol dose in the management of early pregnancy failure
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We aimed to assess the role of repeat misoprostol administration in those with thickened endometrium in the management of early pregnancy failure (EPF).
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
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.
Repeat misoprostol administration among women with thickened endometrium following initial misoprostol administration for EPF was not associated with improved treatment success rates.
KeywordsMisoprostol Early pregnancy failure Medical management Repeat dose Retained products of conception Thickened endometrium
Assisted reproductive technologies
Dilatation and curettage
Manual vacuum aspiration
We thank Ms. Sara Cohen for her editorial assistance.
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.
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).
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