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Onsod P, Jaranasaksakul W, Chareonsirisuthigul T, Parinayok R, Rerkamnuaychoke B, Areesirisuk P. Chromosomal abnormalities study for anembryonic pregnancy by BACs-on-Beads technique. Eur J Obstet Gynecol Reprod Biol 2024; 298:31-34. [PMID: 38705011 DOI: 10.1016/j.ejogrb.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/20/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE This study evaluated the BACs-on-Beads™ (BoBs) efficiency assay in detecting chromosomal anomalies in products of conception (POC) specimens associated with anembryonic pregnancy (AP) among Thai pregnant women. METHOD Retrospective analysis applied the BoBs™ assay to examine AP samples from 2010 to 2022. The incidences of AP with chromosomal abnormalities were reported. RESULT Assessment of villi from anembryonic pregnancy samples found normal chromosome complement in 50% of the cases, while the remainder showed chromosomal abnormalities. Trisomy 16 was found in 15% of the cases and trisomies 22, 15, and 19 in 9.6%, 3.8%, and 3.8%, respectively. Advanced maternal age was associated with a higher incidence of aneuploidy. CONCLUSION The BoBs™ assay effectively detected diverse chromosomal abnormalities in villi samples from POC. The diagnostic utility of the BoBs™ assay was highlighted in identifying chromosomal irregularities in AP cases. Trisomy 16 possessed the most chromosomal abnormalities in the AP samples.
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Affiliation(s)
- Preyaporn Onsod
- Human Genetic Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand
| | - Watcharapa Jaranasaksakul
- Human Genetic Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand
| | - Takol Chareonsirisuthigul
- Human Genetic Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand
| | - Rachanee Parinayok
- Human Genetic Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand
| | - Budsaba Rerkamnuaychoke
- Human Genetic Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand
| | - Prapatsorn Areesirisuk
- Human Genetic Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchatewi, Bangkok, Thailand.
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Cohen A, Karavani G, Zamir A, Hadar A, Chill HH, Zini A. Does ultrasound guidance during dilation and curettage for first trimester missed abortion reduce complication rates? Minerva Obstet Gynecol 2024; 76:238-243. [PMID: 36345905 DOI: 10.23736/s2724-606x.22.05192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Dilation and curettage (D&C) may be performed with or without transabdominal ultrasound guidance. The aim of this study was to evaluate the association between the use of ultrasound guidance during D&C for first trimester missed abortion (MA) and D&C related complication rates. METHODS A retrospective cohort study included women in the age of 20-45 years, who underwent D&C for first-trimester MA in a hospital-based setting between 2013-2019. The study population was divided into two groups: the study group which included women who underwent D&C with ultrasound guidance (US group) and the control group, which included women who underwent D&C without ultrasound guidance (N-US group). Gynecologic, obstetric, and operative related data were collected from electronic medical records. RESULTS Three-hundred and seventy-eight women were included in the study, 86 women in the US group and 292 women in N-US group. Baseline maternal characteristics and procedure-related characteristics did not differ between the groups. No significant difference between the US group and N-US group was shown when comparing D&C related complications, including retained products of conception rate (2.3% vs. 5.5%, respectively; P=0.385), uterine perforation rate (1.2% vs. 0.3%, respectively; P=0.404), and the total complication rate (8.1% vs. 12.3%, respectively; P=0.338). In a multivariate analysis, the use of ultrasound guidance during D&C was not found to be associated with lower complication rate (adjusted odds ratio [aOR] 95% confidence interval [CI] 1.468 [0.578-3.729], P=0.419). CONCLUSIONS Performance of D&C under ultrasound guidance for first-trimester MA, in a hospital-based setting, was not associated with lower complication rate, suggesting that the common practice of performing D&C without the use of ultrasound is an acceptable approach.
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Affiliation(s)
- Adiel Cohen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel -
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amit Zamir
- Department of Obstetrics and Gynecology, Kaplan Medical Center Affiliated to the Hebrew University-Hadassah School of Medicine, Rehovot, Israel
| | - Ayalon Hadar
- Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel
| | - Henry H Chill
- Pritzker School of Medicine, Division of Urogynecology, University of Chicago, NorthShore University Health System, Skokie, IL, USA
| | - Avraham Zini
- Faculty of Dental Medicine, Hebrew University Medical School, Jerusalem, Israel
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Silva TMD, Araujo MAGD, Simões ACZ, Oliveira RD, Medeiros KSD, Sarmento AC, Medeiros RDD, Costa APF, Gonçalves AK. Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e808-e817. [PMID: 38141602 DOI: 10.1055/s-0043-1776029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Abstract
OBJECTIVE To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. DATA SOURCES The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. SELECTION OF STUDIES Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. DATA COLLECTION Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. DATA SYNTHESIS When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07-0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96-4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52-0.80). No statistically significant differences were observed in the general acceptability of the treatments. CONCLUSION Misoprostol has been determined as a safe option with good acceptance by patients.
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Affiliation(s)
- Thiago Menezes da Silva
- Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | | | | | - Ronnier de Oliveira
- Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Kleyton Santos de Medeiros
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
- Instituto de Ensino, Pesquisa e Inovação, Liga Contra o Câncer, Natal, RN, Brazil
| | | | - Robinson Dias de Medeiros
- Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | | | - Ana Katherine Gonçalves
- Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
- Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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Blavier F, Grobet D, Duflos C, Rayssiguier R, Ranisavljevic N, Duport Percier M, Rodriguez A, Blockeel C, Santos-Ribeiro S, Faron G, Gucciardo L, Fuchs F. Usability, accuracy, and cost-effectiveness of a medical software for early pregnancies: a retrospective study. Hum Reprod 2023; 38:549-559. [PMID: 36762880 DOI: 10.1093/humrep/dead025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/13/2023] [Indexed: 02/11/2023] Open
Abstract
STUDY QUESTION Can early pregnancies be accurately and cost-effectively diagnosed and managed using a new medical computerized tool? SUMMARY ANSWER Compared to the standard clinical approach, retrospective implementation of the new medical software in a gynaecological emergency unit was correlated with more accurate diagnosis and more cost-effective management. WHAT IS KNOWN ALREADY Early pregnancy complications are responsible for a large percentage of consultations, mostly in emergency units, with guidelines becoming complex and poorly known/misunderstood by practitioners. STUDY DESIGN, SIZE, DURATION A total of 780 gynaecological emergency consultations (446 patients), recorded between November 2018 and June 2019 in a tertiary university hospital, were retrospectively encoded in a new medical computerized tool. The inclusion criteria were a positive hCG test result, ultrasonographical visualization of gestational sac, and/or embryo corresponding to a gestational age of 14 weeks or less. Diagnosis and management suggested by the new computerized tool are named eDiagnoses, while those provided by a gynaecologist member of the emergency department staff are called medDiagnoses. PARTICIPANTS/MATERIALS, SETTING, METHODS Usability was the primary endpoint, with accuracy and cost reduction, respectively, as secondary and tertiary endpoints. Identical eDiagnoses/medDiagnoses were considered as accurate. During follow-up visits, if the updated eDiagnoses and medDiagnoses became both identical to a previously discrepant eDiagnosis or medDiagnosis, this previous eDiagnosis or medDiagnosis was also considered as correct. Four double-blinded experts reviewed persistent discrepancies, determining the accurate diagnoses. eDiagnoses/medDiagnoses accuracies were compared using McNemar's Chi square test, sensitivity, specificity, and predictive values. MAIN RESULTS AND THE ROLE OF CHANCE Only 1 (0.1%) from 780 registered medical records lacked data for full encoding. Out of the 779 remaining consultations, 675 eDiagnoses were identical to the medDiagnoses (86.6%) and 104 were discrepant (13.4%). From these 104, 60 reached an agreement during follow-up consultations, with 59 medDiagnoses ultimately changing into the initial eDiagnoses (98%) and only one discrepant eDiagnosis turning later into the initial medDiagnosis (2%). Finally, 24 remained discrepant at all subsequent checks and 20 were not re-evaluated. Out of these 44, the majority of experts agreed on 38 eDiagnoses (86%) and 5 medDiagnoses (11%, including four twin pregnancies whose twinness was the only discrepancy). No majority was reached for one discrepant eDiagnosis/medDiagnosis (2%). In total, the accuracy of eDiagnoses was 99.1% (675 + 59 + 38 = 772 eDiagnoses out of 779), versus 87.4% (675 + 1 + 5 = 681) for medDiagnoses (P < 0.0001). Calculating all basic costs of extra consultations, extra-medications, extra-surgeries, and extra-hospitalizations induced by incorrect medDiagnoses versus eDiagnoses, the new medical computerized tool would have saved 3623.75 Euros per month. Retrospectively, the medical computerized tool was usable in almost all the recorded cases (99.9%), globally more accurate (99.1% versus 87.4%), and for all diagnoses except twinning reports, and it was more cost-effective than the standard clinical approach. LIMITATIONS, REASONS FOR CAUTION The retrospective study design is a limitation. Some observed improvements with the medical software could derive from the encoding by a rested and/or more experienced physician who had a better ultrasound interpretation. This software cannot replace clinical and ultrasonographical skills but may improve the compliance to published guidelines. WIDER IMPLICATIONS OF THE FINDINGS This medical computerized tool is improving. A new version considers diagnosis and management of multiple pregnancies with their specificities (potentially multiple locations, chorioamnionicity). Prospective evaluations will be required. Further developmental steps are planned, including software incorporation into ultrasound devices and integration of previously published predictive/prognostic factors (e.g. serum progesterone, corpus luteum scoring). STUDY FUNDING/COMPETING INTEREST(S) No external funding was obtained for this study. F.B. and D.G. created the new medical software. TRIAL REGISTRATION NUMBER NCT03993015.
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Affiliation(s)
- F Blavier
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.,Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Obstetrics and Gynecology, Hospital Center of Orange, Orange, France
| | - D Grobet
- Lecturer Computer Science, Brussels Engineering School (ISIB), Brussels, Belgium
| | - C Duflos
- Clinical Research and Epidemiology Unit, CHU Montpellier, Université Montpellier, Montpellier, France
| | - R Rayssiguier
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - N Ranisavljevic
- ART-PGD Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - M Duport Percier
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - A Rodriguez
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - C Blockeel
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - G Faron
- Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - L Gucciardo
- Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - F Fuchs
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.,Inserm, CESP Center for Research in Epidemiology and Population Health, U1018, Reproduction and Child Development, Villejuif, France.,Desbret Institute of Epidemiology and Public Health, University of Montpellier, Montpellier, France
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5
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Bar-Noy T, Nahshon C, Abu Nasra L, Ostrovsky L, Sagi-Dain L. Factors Affecting the Success of Repeated Misoprostol Course for the Treatment of Missed Abortion. J Gynecol Obstet Hum Reprod 2022; 51:102477. [DOI: 10.1016/j.jogoh.2022.102477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/07/2022] [Accepted: 09/10/2022] [Indexed: 11/26/2022]
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6
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Meshaal H, Salah E, Fawzy E, Abdel-Rasheed M, Maged A, Saad H. Hysteroscopic management versus ultrasound-guided evacuation for women with first-trimester pregnancy loss, a randomised controlled trial. BMC Womens Health 2022; 22:190. [PMID: 35614405 PMCID: PMC9131545 DOI: 10.1186/s12905-022-01774-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the hysteroscopic management of first-trimester pregnancy loss compared to surgical evacuation either blind or under ultrasonographic guidance. METHODS This clinical trial included 315 women with first-trimester pregnancy loss, divided equally into three groups. Group 1 underwent traditional blind surgical evacuation, group 2 underwent ultrasound-guided evacuation, and group 3 underwent hysteroscopic management. All women were assessed for retained products, surgical complications, the need for further management, and pregnancy occurrence after evacuation within 2 years of follow up. RESULTS The rate of presence of conception remnants and the need for further treatment was significantly higher in group 1 compared to groups 2 and 3 (4.8% vs. 0% vs. 0%, P = 0.012). The conception rate within 2 years was significantly lower in group 1 compared to groups 2 and 3 (57.4% vs. 73.2% vs. 82.7%, P = 0.002), and the duration needed to conceive was significantly prolonged in group 1 compared to groups 2 and 3 (9.8 vs. 8.3 vs. 6.9 months, P < 0.001). Interestingly, women who underwent hysteroscopic management needed a significantly shorter time to conceive than those who underwent ultrasound-guided evacuation (6.9 vs. 8.3 months, P = 0.006). CONCLUSIONS Hysteroscopic management of first-trimester pregnancy loss was superior to ultrasound-guided surgical evacuation regarding the time interval to conceive. Both techniques were superior to the blind evacuation technique regarding removal of the whole conception remnants, need for further treatment and fertility outcomes. Clinical trial registration: It was first registered at ClinicalTrials.gov on 16/03/2017 with registration number NCT03081104.
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Affiliation(s)
- Hadeer Meshaal
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Emad Salah
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Fawzy
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mazen Abdel-Rasheed
- Reproductive Health Research Department, National Research Centre, 33 El-Buhouth St, Dokki, Cairo, 12622, Egypt.
| | - Ahmed Maged
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany Saad
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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7
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Wylie M, Srajer A, Zaver F, Lonergan K, Brain P, Lang E. Management of incomplete and missed spontaneous abortions: a cohort study of trends in Calgary emergency departments. CAN J EMERG MED 2022; 24:278-282. [PMID: 35239170 DOI: 10.1007/s43678-022-00273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Incomplete and missed spontaneous abortion cases often first present to the emergency department (ED), where they can be managed operatively via dilation and curettage (D&C) or non-operatively through medical or expectant management. The primary objective of this study was to determine how rates of operative management have changed over time across Calgary EDs. The secondary objective was to assess correlates of effectiveness and potential drivers in management including gynecological consults, ED return visits requiring admission, and subsequent D&Cs. METHODS Sunrise Clinical Manager (electronic medical system) was accessed to collect data for patients who presented to a Calgary ED with an incomplete or missed spontaneous abortion from 2014 to 2019. Patients requiring resuscitation and those with complications were excluded. Return to care for D&C and ED revisits requiring admission were used as a proxy for failed non-operative management. Trends in management are reported using 95% confidence intervals. RESULTS Of the 3845 patients included, 1110 (28.9%) received a D&C on initial ED visit. The remaining 2735 (71.1%) were initially managed non-operatively. Rates of D&Cs decreased 11.6% from 2014 to 2019, 95% CI (6.5%, 16.8%). There was minimal change in the rates of gynecological consults, ED returns requiring admission, and returns to care resulting in D&Cs over time. CONCLUSIONS The management of incomplete and missed spontaneous abortions has shifted toward non-operative management over 6 years in Calgary. As this is not associated with increased ED returns requiring admission or subsequent D&Cs, the shift appears to be appropriate. As gynecological consults were consistent over time, further knowledge translation around non-operative spontaneous abortion management may be useful for ED physicians.
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Affiliation(s)
- Megg Wylie
- Cumming School of Medicine, University of Calgary, 204-1331 14th Avenue SW, Calgary, AB, T3C 0W3, Canada.
| | - Amelia Srajer
- Cumming School of Medicine, University of Calgary, 204-1331 14th Avenue SW, Calgary, AB, T3C 0W3, Canada
| | - Fareen Zaver
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Kevin Lonergan
- Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Philippa Brain
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
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Du L, Li RHW, Gemzell-Danielsson K, Du YH, Zhang L, Diao WY, Ho PC. Prospective open-label non-inferiority randomised controlled trial comparing letrozole and mifepristone pretreatment in medical management of first trimester missed miscarriage: study protocol. BMJ Open 2022; 12:e052192. [PMID: 35105623 PMCID: PMC8808382 DOI: 10.1136/bmjopen-2021-052192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Medical treatment is a less invasive alternative to surgical management of missed miscarriage. Studies have shown that pretreatment with mifepristone can increase the complete abortion rate in management of first-trimester missed miscarriage compared with misoprostol alone. Two studies have also shown that pretreatment with letrozole could increase the efficacy compared with misoprostol alone. So far, there is no trial comparing letrozole and mifepristone pretreatment for missed miscarriage. We designed this randomised controlled trial to test the hypothesis that for first-trimester missed miscarriage, letrozole pretreatment is non-inferior to mifepristone pretreatment followed by misoprostol in terms of complete abortion rate. METHODS AND ANALYSIS This is a prospective open-label non-inferiority randomised controlled trial conducted in a single centre. In total, 294 women diagnosed with first-trimester missed miscarriage opting for medical treatment is recruited with informed consent. They are randomly assigned to receive mifepristone or letrozole pretreatment. In the mifepristone group, each woman takes 200 mg mifepristone orally followed 24-48 hours later by 800 µg misoprostol vaginally. In the letrozole group, each woman takes 10 mg letrozole orally per day for 3 days, followed by 800 µg misoprostol vaginally on the third day of letrozole administration. Follow-up is conducted on days 15 and 42 after misoprostol administration. The primary outcome is the overall complete abortion rate. Secondary outcomes include side effects and complications during the study period. Data will be analysed with both intention-to-treat and per protocol approaches. A p<0.05 will be considered as indicating statistical significance. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Institutional Review Board of the University of Hong Kong-Shenzhen Hospital with approval number: (2020)166. Findings will be disseminated in a peer-reviewed journal and in national and/or international meetings to guide future practice. TRIAL REGISTRATION NUMBER ChiCTR2000041480.
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Affiliation(s)
- Libei Du
- Department of Obstetrics and Gynecology, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Raymond Hang Wun Li
- Department of Obstetrics and Gynecology, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Kristina Gemzell-Danielsson
- Department of Obstetrics and Gynecology, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Yan Hong Du
- Department of Obstetrics and Gynecology, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Li Zhang
- Department of Obstetrics and Gynecology, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Wei Yu Diao
- Department of Obstetrics and Gynecology, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Pak Chung Ho
- Department of Obstetrics and Gynecology, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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9
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Taylor C, Ellett L, Hiscock R, Mooney S. Hysteroscopic management of retained products of conception: A systematic review. Aust N Z J Obstet Gynaecol 2021; 62:22-32. [PMID: 34751942 DOI: 10.1111/ajo.13455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The management of retained products of conception (RPOC) is not well standardised due to a lack of evidence-based guidelines. Hysteroscopic resection has been proven to be safe and is hypothesised to have lower risk than dilation and curettage, but data comparing the two directly are limited. AIM The aim of this study is to evaluate the outcomes for hysteroscopic resection for the management of RPOC in comparison to current standard management techniques. METHODS A literature search was conducted in September 2019 using MEDLINE, Scopus, The Cochrane Library and Web of Science. The key search terms were 'hysteroscopy'/'hysteroscopic resection' and 'retained products of conception'/'RPOC'. Both prospective and retrospective studies were included. A total of 19 studies were included (n = 2314). Due to a critical risk of bias in all studies with a comparison arm, a meta-analysis was not performed. Meta-analysis techniques were still used to provide summary estimates for primary and secondary outcomes, including conception rate, time to conception, live birth rate, intrauterine adhesions (IUAs), surgical complications and future pregnancy complications. RESULTS The overall conception rate for hysteroscopic resection was 81.1% (live birth rate 87.3%) compared to 65.4% for non-hysteroscopic management (live birth rate 93.8%). After hysteroscopic resection the overall complication rate was 1.9% and the IUA rate was 6.8%. CONCLUSIONS Due to the poor quality and overall scarcity of comparative data, the question whether hysteroscopic resection is superior to traditional curettage for the management of RPOC remains unanswered. This review provides summary data, which will enable the design of adequately powered future studies.
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Affiliation(s)
- Cassandra Taylor
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Joan Kirner Women's and Children's Hospital, Western Health, Melbourne, Victoria, Australia
| | - Lenore Ellett
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Richard Hiscock
- Mercy Perinatal at Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Samantha Mooney
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
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10
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Hamel CC, van Wessel S, Carnegy A, Coppus SFPJ, Snijders MPML, Clark J, Emanuel MH. Diagnostic criteria for retained products of conception-A scoping review. Acta Obstet Gynecol Scand 2021; 100:2135-2143. [PMID: 34244998 PMCID: PMC9291104 DOI: 10.1111/aogs.14229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/10/2021] [Accepted: 07/02/2021] [Indexed: 11/28/2022]
Abstract
Introduction Numerous studies have been performed assessing optimal treatment regimens for evacuating (retained) products of conception from the uterus, but standardized criteria for diagnosing retained products of conception (RPOC) are still lacking. We aim to provide an overview of diagnostic criteria in current literature, used to diagnose RPOC after induced first‐trimester abortion or early pregnancy loss. Material and methods Pubmed, EMBASE, and the Cochrane library were searched systematically up until March 2020 for English articles reporting on induced abortion or early pregnancy loss. Articles not specifying diagnostic criteria used to assess completeness of treatment were excluded, as were conference abstracts, expert opinions, reviews, and case reports. Four elements of diagnostic criteria were described: diagnostic tools, parameters used within these tools, applied cut‐off values, and timing of follow up. Additionally, a meta‐analysis was performed assessing diagnostic qualities of the most often applied diagnostic tool and parameter. Results The search strategy yielded 1233 unique articles, of which 248 were included, with a total of 339 517 participants. In the 79 included randomized controlled trials, six diagnostic tools to assess RPOC were identified, combined in 14 ways, with 55 different cut‐off values. In 169 observational studies, seven diagnostic tools were identified, used in 28 combinations, applying 89 different cut‐off values. Transvaginal ultrasonographic measurement of endometrial thickness with a cut‐off value of at least 15 mm indicating RPOC, was used most frequently. In the timing of follow‐up there was great variation, with 55 and 107 different combinations in randomized controlled trials and observational studies, respectively. Assessment of treatment success was scheduled most often around 2 weeks after treatment. Diagnostic qualities of endometrial thickness of 15 mm or more was not adequately assessed. Conclusions There is wide variation in the way RPOC are assessed, and the criteria used to define RPOC following induced abortion and early pregnancy loss; ultrasonographic measurement of endometrial thickness, with a cut‐off of 15 mm or more 2 weeks after primary treatment is the most widely used diagnostic approach. A meta‐analysis on diagnostic accuracy of endometrial thickness of 15 mm or more did not lead to solid results. These findings can be a first step to develop a workable standard of establishing RPOC after induced abortion or early pregnancy loss.
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Affiliation(s)
- Charlotte C Hamel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Obstetrics and Gynecology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Steffi van Wessel
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Alasdair Carnegy
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands
| | - Marc P M L Snijders
- Department of Obstetrics and Gynecology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Justin Clark
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark H Emanuel
- Department of Gynecology and Reproductive Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Blavier F, Faron G, Cools W, Blockeel C, Santos-Ribeiro S, Done E, Ranisavljevic N, Rayssiguier R, Fuchs F, Gucciardo L. Corpus luteum score, a simple Doppler examination to prognose early pregnancies. Eur J Obstet Gynecol Reprod Biol 2021; 258:324-331. [PMID: 33524776 DOI: 10.1016/j.ejogrb.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/04/2020] [Accepted: 01/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In early pregnancies, miscarriages and inconclusive ultrasound scans considering location and viability are very common. In several previous studies, serum progesterone levels predicted viability of pregnancy and, in recent ones, failed Pregnancies of Unknown Location (PUL), completion of miscarriage and complications. Corpus luteum, secreting progesterone in early pregnancy, was less studied. Some publications showed correlations between corpus luteum aspects and diagnosis of miscarriage but it was not evaluated for other outcomes in early pregnancy, such as failed PUL, completion of miscarriage or complications. We aimed to assess if Doppler examination of corpus luteum could also predict all these outcomes: failed PUL, diagnosis and completion of miscarriages and complications. STUDY DESIGN A single operator prospectively described and/or collected pictures of Doppler signal in the wall of the corpus luteum at most consultations in our early pregnancy unit and established a three-level score. All suspected or confirmed non-viable pregnancies with this score or/and serum progesterone levels were registered retrospectively. With logistic regressions, AIC/BIC, likelihood ratios, ROC curves, Mann-Whitney and Fisher exact tests, we evaluated the ability of the score, alone, to predict failed PUL, diagnosis and completion of miscarriages and the complications, and, combined, to improve previously published predictions. RESULTS From 277 included pregnancies, 186 (67.1 %) miscarried. Of these, 159/186 (85.5 %) fully evacuated without surgery: 114/186 (61.3 %) within 20 days after the first diagnosis and 45/186 (24.2 %) after more than 20 days. Twenty-seven patients (14.5 %) underwent surgical evacuation, including ten complications, five haemorrhages and five suspected infections. Logistic regression correlated strongly the corpus luteum score with failed PUL (p < 0.0001) and miscarriages (p < 0.0001). Moreover, rates of complications and swift non-surgical completions of miscarriage were respectively 0 % and 92 % with scores of 0, versus 6 % and 44 % with scores of 1, versus 16 % and 0 % with scores of 2. Combined with serum progesterone levels, this score improved most predictions. Adding parity or history of miscarriage in predictive models even increased these performances. CONCLUSIONS Corpus luteum score, alone, can predict failed PUL, diagnosis and completion of miscarriages and their complications. Combining this score with other factors (mainly serum progesterone levels) improves most predictions.
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Affiliation(s)
- Frederic Blavier
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium; Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.
| | - Gilles Faron
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | - Wilfried Cools
- Interfaculty Centre for Data Processing and Statistics, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | - Christophe Blockeel
- Centre for Reproductive Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | | | - Elisa Done
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
| | - Noemie Ranisavljevic
- ART-PGD Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Romy Rayssiguier
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Florent Fuchs
- Department of Obstetrics and Prenatal Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Leonardo Gucciardo
- Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium
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13
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Barratt O, Lee R, Curtin C. First trimester miscarriage: patient care considerations for the dental team. Br Dent J 2020; 229:527-531. [PMID: 33097886 DOI: 10.1038/s41415-020-2224-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/20/2020] [Indexed: 01/06/2023]
Abstract
First trimester miscarriage is common, occurring in approximately 6.4-12.0% of pregnancies. Women who experience first trimester miscarriage will often have no other significant health conditions and the healthcare professional they most frequently visit could be their dentist or dental care professional. For this reason, it is important that the dental team is aware of the management of first trimester miscarriage in order to allow for a better understanding of the patient's experience and situation. The choice of language used by healthcare professionals with patients who are grieving is also important to ensure effective and open communication.This article aims to provide the dental team with knowledge of first trimester miscarriage, how the effects of this can be relevant within the dental setting, and how to communicate effectively and appropriately with patients who have experienced this traumatic event.
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Affiliation(s)
- Olivia Barratt
- DCT 2 in Restorative Dentistry, University Dental Hospital, Cardiff & Vale University Health Board, Heath Park, Cardiff, CF14 4XY, UK.
| | - Rachel Lee
- ST5 Obstetrics and Gynaecology, Welsh Clinical Leadership Fellow, Health Education and Improvement Wales, UK
| | - Claire Curtin
- Consultant in Acute & Special Care Dentistry, University Dental Hospital, Cardiff & Vale University Health Board, Heath Park, Cardiff, CF14 4XY, UK
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Tzur Y, Samueloff O, Raz Y, Bar-On S, Laskov I, Tzur T. Conception rates after medical versus surgical evacuation of early miscarriage. Fertil Steril 2020; 115:118-124. [PMID: 32811672 DOI: 10.1016/j.fertnstert.2020.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare short-term fertility rates after medical and surgical management of early miscarriage. DESIGN Observational cohort study. SETTING Academic tertiary-care medical center. PATIENT(S) A total of 203 patients were enrolled between June 2017 and May 2018, comprising 106 surgical evacuations and 97 medical evacuations. INTERVENTION(S) Either surgical or medical evacuation of the uterine cavity. MAIN OUTCOME MEASURE(S) Conception rates 6 months after miscarriage. RESULT(S) Conception rates 6 months after miscarriage among women who had attempted to become pregnant were similar between the medically and surgically evacuated groups (68.0% vs. 65.1%). There were no significant differences in background characteristics between the groups, apart from younger age and earlier gestational age among the medically treated group. There was no difference in the proportion of women using assisted reproductive technologies between the medically and surgically managed groups (15.5% vs. 12.6%, respectively). The median time-to-conception was 4 ± 2 months in both groups. Cumulative pregnancy rate 12 months after pregnancy loss, live birth rate, and repeat miscarriage rate also were similar between groups. CONCLUSION(S) Modality of uterine evacuation after early miscarriage does not affect short-term fertility outcomes.
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Affiliation(s)
- Yossi Tzur
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Ofri Samueloff
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Raz
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Shikma Bar-On
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Laskov
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Tzur
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Mizrachi Y, Ben-Ezry E, Kleiner I, Friedman G, Kerner R, Bar J, Raziel A, Weissman A, Sagiv R. Reproductive outcome after early pregnancy loss treated with misoprostol versus surgical aspiration. Reprod Biomed Online 2020; 41:707-713. [PMID: 32819838 DOI: 10.1016/j.rbmo.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/30/2020] [Accepted: 07/07/2020] [Indexed: 12/20/2022]
Abstract
RESEARCH QUESTION Does long-term reproductive outcome after early pregnancy loss (EPL) differ between women who are treated with misoprostol and surgical aspiration. DESIGN A historic cohort study of all women who were diagnosed with early pregnancy loss (≤12 weeks), in a single medical centre, between September 2016 and August 2017, was conducted. The women were treated with either misoprostol or surgical aspiration according to their own preferences. Women who were lost to follow-up or did not attempt to conceive again were excluded. The primary outcome measure was the cumulative pregnancy rate within 12 months from intervention. RESULTS Baseline characteristics were comparable between women who received misoprostol (n = 163) and women who underwent surgical aspiration (n = 122). Women who received misoprostol had a higher rate of interventions for retained products of conception (11.0% versus 3.3%, respectively; P = 0.015). The misoprostol and the surgical aspiration groups did not differ in rate of repeated miscarriages (17.8% versus 21.3%, respectively; P = 0.45), or pregnancy rate within 6 months (58.3% versus 50.0%, respectively; P = 0.16), 12 months (78.5% versus 78.7%, respectively; P = 0.97) and 24 months (92.0% versus 91.8%, respectively; P = 0.94). Live birth rate within 24 months was comparable (62.0% versus 58.2%, respectively; P = 0.52), as well as gestational age at birth (38.5 versus 38.6 weeks, respectively; P = 0.81) and birthweight (3295 versus 3161 g, respectively; P = 0.07). CONCLUSIONS Long-term reproductive outcomes are comparable in women with EPL who are treated with either misoprostol or surgical aspiration. Our findings may help counselling patients facing EPL who have concerns about their future reproduction.
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Affiliation(s)
- Yossi Mizrachi
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Emilie Ben-Ezry
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilia Kleiner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gil Friedman
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ram Kerner
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arieh Raziel
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Weissman
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, P.O. Box 5, Holon 58100, Israel, affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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H Al Wattar B, Murugesu N, Tobias A, Zamora J, Khan KS. Management of first-trimester miscarriage: a systematic review and network meta-analysis. Hum Reprod Update 2020; 25:362-374. [PMID: 30753490 DOI: 10.1093/humupd/dmz002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/13/2018] [Accepted: 01/09/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND First-trimester miscarriage affects up to a quarter of women worldwide. With many competing treatment options available, there is a need for a comprehensive evidence synthesis. OBJECTIVES AND RATIONALE We conducted a systematic review and network meta-analysis to assess the effectiveness and safety of treatment options for first-trimester miscarriage: expectant management (EXP), sharp dilation and curettage (D+C), electric vacuum aspiration (EVAC), manual vacuum aspiration (MVA), misoprostol alone (MISO), mifepristone+misoprostol (MIFE+MISO) and misoprostol plus electric vacuum aspiration (MISO+EVAC). SEARCH METHODS We searched MEDLINE, Embase, CINAHL, AMED and Cochrane Library from inception till June 2018. We included randomized trials of women with first-trimester miscarriage (<14 weeks gestation) and conducted a network meta-analysis generating both direct and mixed evidence on the effectiveness and side effects of available treatment options. The primary outcome was complete evacuation of products of conception. We assessed the risk of bias and the global network inconsistency. We compared the surface under the cumulative ranking curve (SUCRA) for each treatment. OUTCOMES A total of 46 trials (9250 women) were included. The quality of included studies was overall moderate with some studies demonstrating a high risk of bias. We detected unexplained inconsistency in evidence loops involving MIFE+MISO and adjusted for it. EXP had lower effectiveness compared to other treatment options. The effectiveness of medical treatments was similar compared to surgery. Mixed evidence of low confidence suggests increased effectiveness for MIFE+MISO compared to MISO alone (RR 1.49, 95% CI: 1.09-2.03). Side effects were similar among all options. Fewer women needed analgesia following EVAC compared to MISO (RR for MISO 0.43, 95% CI: 0.27-0.68) and in the EXP group compared to EVAC (RR 2.07, 95% CI: 1.25-3.41). MVA had higher ranking (low likelihood) for post-treatment infection and serious complications (SUCRA 87.6 and 79.2%, respectively) with the highest likelihood for post-treatment satisfaction (SUCRA 98%). WIDER IMPLICATIONS Medical treatments for first-trimester miscarriage have similar effectiveness and side effects compared to surgery. The addition of MIFE could increase the effectiveness of MISO and reduce side effects, although evidence is limited due to inconsistency. EXP has lower effectiveness compared to other treatment options.Systematic review registration: Prospero CRD42016048920.
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Affiliation(s)
- Bassel H Al Wattar
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Nilaani Murugesu
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - Javier Zamora
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK.,Clinical Biostatistics Unit, Ramon y Cajal Hospital (IRYCIS) and CIBER Epidemiology and Public Health, Madrid, Spain
| | - Khalid S Khan
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK.,Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Vafaei H, Ajdari S, Hessami K, Hosseinkhani A, Foroughinia L, Asadi N, Faraji A, Abolhasanzadeh S, Bazrafshan K, Roozmeh S. Efficacy and safety of myrrh in patients with incomplete abortion: a randomized, double-blind, placebo-controlled clinical study. BMC Complement Med Ther 2020; 20:145. [PMID: 32397980 PMCID: PMC7218551 DOI: 10.1186/s12906-020-02946-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background Myrrh (Commiphora myrrha (Nees) Engl.) has a long history of traditional use as a herbal medicine for different purposes. In ancient traditional Persian manuscripts, it has been noted that myrrh may act as uterine stimulant and probably cause complete abortion. However, there is no evidence to verify this comment. Therefore, the current study was carried out to evaluate the efficacy and safety of Myrrh in the treatment of incomplete abortion. Materials and methods In a randomized double-blinded placebo controlled clinical trial, 80 patients with ultrasound-documented retained products of conception (RPOC) were assigned to receive capsules containing 500 mg of Myrrh oleo-gum-resin or a placebo three times a day for 2 weeks. The existence of the retained tissue and its size were evaluated by ultrasound examination at the beginning and end of the study. Results After 2 weeks, the mean diameter of the RPOC in the Myrrh group was significantly reduced compared with the placebo group (P < 0.001). Meanwhile, the rate of successful complete abortion was 82.9% in the intervention group and 54.3% in the placebo group (P = 0.01). The patients in both groups reported no serious drug-related adverse effects. Conclusion This study shows that Myrrh is effective and safe in the resolution of the RPOC and may be considered as an alternative option for treatment of patients with incomplete abortion. However, further studies on active compounds isolated from myrrh and their uterine stimulant effects are needed. Trial registration This study was retrospectively registered at Iranian Registry of Clinical Trials (www.irct.ir) IRCT code: IRCT20140317017034N7.
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Affiliation(s)
- Homeira Vafaei
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Ajdari
- Obstetrics and Gynecology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ayda Hosseinkhani
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Foroughinia
- Obstetrics and Gynecology Department, Shiraz University of Medical Sciences, Shiraz, Iran.,Box Hill Hospital, FRANZCOG Eastern Health, Victoria, Australia
| | - Nasrin Asadi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Maternal- Fetal Medicine (Perinatology), Hafez Hospital, Chamran Ave, Shiraz, Iran.
| | - Azam Faraji
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Khadije Bazrafshan
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shohreh Roozmeh
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Serum progesterone levels could predict diagnosis, completion and complications of miscarriage. J Gynecol Obstet Hum Reprod 2020; 49:101721. [DOI: 10.1016/j.jogoh.2020.101721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/16/2019] [Accepted: 02/16/2020] [Indexed: 11/19/2022]
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19
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Ehrnstén L, Altman D, Ljungblad A, Kopp Kallner H. Efficacy of mifepristone and misoprostol for medical treatment of missed miscarriage in clinical practice—A cohort study. Acta Obstet Gynecol Scand 2020; 99:488-493. [DOI: 10.1111/aogs.13780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Lisa Ehrnstén
- Department of Clinical Sciences Danderyd Hospital Karolinska Institutet Stockholm Sweden
- Stockholm Urogyn Clinic Solna Sweden
| | - Daniel Altman
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Anton Ljungblad
- Gynecology and Surgery Sophiahemmet Hospital Stockholm Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences Danderyd Hospital Karolinska Institutet Stockholm Sweden
- Stockholm Urogyn Clinic Solna Sweden
- Department of Obstetrics and Gynecology Danderyd Hospital Stockholm Sweden
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20
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Namazov A, Elkabetz N, Ivshin E, Zohav E, Shenhav S, Kapustian V, Anteby EY, Gemer O. Routine ultrasonographic and hysteroscopic evaluations of women undergoing postpartum manual removal of placenta: a retrospective cohort study. Arch Gynecol Obstet 2020; 301:715-719. [PMID: 31950246 DOI: 10.1007/s00404-020-05433-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/03/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to assess the rates of retained products of conception (RPOC) after routine postpartum evaluation of patients who underwent post-delivery manual uterine revision due to retained placenta. METHODS This is a retrospective cohort study of 599 consecutive women who underwent manual removal of placenta during 2010-2018. Group A comprised 465 women who underwent postpartum symptom-based evaluation (2010-2016). Group B comprised 134 women who were routinely evaluated by ultrasound and subsequently by hysteroscopic examination 6 weeks after delivery (2016-2018). RESULTS The rates of abnormal postpartum bleeding were similar between groups A and B (12% and 13%, respectively, p = 0.72%). A significantly smaller proportion of women underwent hysteroscopy in group A than group B (12% vs. 37%, p < 0.05). The rate of persistent RPOC confirmed by hysteroscopy was significantly lower in group A than group B (9.7% vs. 23%, p < 0.05). CONCLUSION Among patients who underwent post-delivery manual removal of placenta, a threefold higher rate of RPOC was discovered by routine elective evaluation than by evaluating only symptomatic patients. Future studies may show whether this approach translates to an effect on fertility.
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Affiliation(s)
- Ahmet Namazov
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, HaHistadrut Street 2, Ashkelon, Israel.
- Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel.
| | - Natanel Elkabetz
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, HaHistadrut Street 2, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel
| | - Ela Ivshin
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, HaHistadrut Street 2, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel
| | - Efraim Zohav
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, HaHistadrut Street 2, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel
| | - Simon Shenhav
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, HaHistadrut Street 2, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel
| | - Victoria Kapustian
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, HaHistadrut Street 2, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel
| | - Eyal Y Anteby
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, HaHistadrut Street 2, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel
| | - Ofer Gemer
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, HaHistadrut Street 2, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of Negev, Beer-Sheva, Israel
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San Lazaro Campillo I, Meaney S, O'Donoghue K, Corcoran P. Miscarriage hospitalisations: a national population-based study of incidence and outcomes, 2005-2016. Reprod Health 2019; 16:51. [PMID: 31072391 PMCID: PMC6507132 DOI: 10.1186/s12978-019-0720-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 04/15/2019] [Indexed: 12/05/2022] Open
Abstract
Background Early miscarriage is one of the most common obstetric causes of maternal morbidity early in pregnancy. However, data concerning non-fatal complications among hospitalisations for early miscarriage are lacking. The aim of this study was to determine whether there were changes in the incidence, management and outcomes of early miscarriage hospitalisations between 2005 and 2016. Methods This is a nationwide population-based study of 50,538 hospitalisations with a diagnosis of early miscarriage of all acute maternity hospitals in Ireland. Electronic health records were retrieved using the Hospital In-Patient Enquiry database. Main outcomes include the incidence rates of hospitalisations and management for early miscarriage, and rates of blood transfusion and length of stay over 2 days. Results Overall, 50,538 hospitalisations for early miscarriage were identified from 2005 to 2016. The risk of hospitalisation decreased from 70.6 per 1000 deliveries (95% CI 68.4 to 72.8) in 2005 to 49.7 per 1000 deliveries (95% CI 49.7 to 53.3) in 2016; however, the risk of blood transfusion increased over time (ratio: 2.0; 95% CI 1.6 to 2.4). Women of advanced maternal age had a higher risk of hospitalisations. There were less blood transfusions among women who undertook medical treatment (ratio: 0.3; 95% CI 0.1 to 0.5), but they had an increased risk of staying over 2 days at the hospital (ratio: 1.5; 95% CI 1.2 to 1.9) compared to evacuation of retained products of conception. Conclusions Hospitalisation rates for early miscarriage decreased over time with an increase in risk of blood transfusion and an extended length of stay at the hospital. Women who underwent medical management did not have as many blood transfusions as those undergoing surgical management. However, they had an increased risk of an extended stay. Research is needed to explore both outpatient and inpatient settings in order to improve the management and care provided. Electronic supplementary material The online version of this article (10.1186/s12978-019-0720-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Indra San Lazaro Campillo
- Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research University College Cork, Cork, Ireland. .,National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, 5th floor, Postgraduate Study Room, 5S-30, Wilton, Cork, T12 YE02, Ireland.
| | - Sarah Meaney
- Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research University College Cork, Cork, Ireland.,National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, 5th floor, Postgraduate Study Room, 5S-30, Wilton, Cork, T12 YE02, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, The Irish Centre for Fetal and Neonatal Translational Research University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Paul Corcoran
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, 5th floor, Postgraduate Study Room, 5S-30, Wilton, Cork, T12 YE02, Ireland.,School of Public Health, University College Cork, Cork, Ireland
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Abstract
Early pregnancy loss is the most common complication in pregnancy. Management options for miscarriage include expectant management, medical intervention, or surgical aspiration. Non-surgical and surgical management are all safe and acceptable options for medically uncomplicated patients. Patient and provider preferences contribute profoundly to clinical decisions about miscarriage management. Shared-decision making and evidence based counseling have been shown to significantly improve patient satisfaction with early pregnancy loss care. This review article will discuss the epidemiology and risk factors of early pregnancy loss, current evidence and clinical practice guidelines around management options, and provider and patient preferences for early pregnancy loss management.
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Affiliation(s)
- Jade M Shorter
- Department of Obstetrics and Gynecology, University of Pennsylvania, 3400 Spruce Street, 1000 Courtyard, Philadelphia, PA 19104, USA
| | - Jessica M Atrio
- Department of Obstetrics and Gynecology, Montefiore Hospital & Albert Einstein College of Medicine, 1695 Eastchester Road Bronx, NY 10461, USA.
| | - Courtney A Schreiber
- Department of Obstetrics and Gynecology, University of Pennsylvania, 3400 Spruce Street, 1000 Courtyard, Philadelphia, PA 19104, USA
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Pinnaduwage L, Honeyford J, Lackie E, Tunde-Byass M. A Comparison of the Number of Patient Visits Required for Different Management Options for Early Pregnancy Loss at an Early Pregnancy Assessment Clinic. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1050-1053. [DOI: 10.1016/j.jogc.2017.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 10/28/2022]
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Hershko Klement A, Frederic M, Bentov Y, Chang P, Nayot D, Haas J, Casper RF. Oral contraceptive pills as an option for non-surgical management of retained products of conception - a preliminary study. Gynecol Endocrinol 2018; 34:609-611. [PMID: 29345165 DOI: 10.1080/09513590.2018.1427714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Many Patients with persistent retained products of conception prefers to avoid surgical interventions, such as a dilatation and curettage (D&C) that might pose an additional future risk to their already compromised fertility or obstetric performance. The aim of this study was to the possibility of induced withdrawal bleeding following oral contraceptive administration as a non-surgical treatment for patients with persistent retained products of conception (RPOC). A retrospective study of patients presenting with retained products of conception (RPOC) after failed expectant management or after treatment with PGE1 was performed. Twelve women presenting with RPOC at ≤8 weeks gestation with minimal to mild vaginal bleeding and no signs of infection were treated with oral contraceptive pill (OCP) containing 0.03 mg ethinylestradiol and 0.15 mg of desogestrel for 3 weeks. Out of the 12 patients treated, nine women (75%) successfully expelled the RPOC after completing the three-week course of OCPs. The three cases (25%) that did not resolve following OCP treatment had pregnancy products with positive blood flow on Doppler examination. We conclude that OCPs may be a useful medical treatment option for persisting RPOC in selected patients with absence blood flow on Doppler examination wishing to avoid surgical intervention.
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MESH Headings
- Abortion, Incomplete/drug therapy
- Abortion, Incomplete/epidemiology
- Abortion, Incomplete/etiology
- Abortion, Induced/adverse effects
- Abortion, Induced/methods
- Abortion, Induced/statistics & numerical data
- Abortion, Spontaneous/drug therapy
- Abortion, Spontaneous/surgery
- Adult
- Choice Behavior
- Contraceptives, Oral, Combined/therapeutic use
- Desogestrel/therapeutic use
- Dilatation and Curettage
- Ethinyl Estradiol/therapeutic use
- Female
- Humans
- Misoprostol/therapeutic use
- Pilot Projects
- Pregnancy
- Pregnancy Trimester, First
- Retrospective Studies
- Tablets
- Treatment Failure
- Uterine Hemorrhage/drug therapy
- Uterine Hemorrhage/epidemiology
- Uterine Hemorrhage/etiology
- Uterine Hemorrhage/surgery
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Affiliation(s)
- Anat Hershko Klement
- a Department of Obstetrics and Gynecology, TRIO Fertility, Toronto and Division of Reproductive Sciences , University of Toronto , Toronto , Canada
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Mitri Frederic
- a Department of Obstetrics and Gynecology, TRIO Fertility, Toronto and Division of Reproductive Sciences , University of Toronto , Toronto , Canada
| | - Yaakov Bentov
- a Department of Obstetrics and Gynecology, TRIO Fertility, Toronto and Division of Reproductive Sciences , University of Toronto , Toronto , Canada
| | - Paul Chang
- a Department of Obstetrics and Gynecology, TRIO Fertility, Toronto and Division of Reproductive Sciences , University of Toronto , Toronto , Canada
| | - Dan Nayot
- a Department of Obstetrics and Gynecology, TRIO Fertility, Toronto and Division of Reproductive Sciences , University of Toronto , Toronto , Canada
| | - Jigal Haas
- a Department of Obstetrics and Gynecology, TRIO Fertility, Toronto and Division of Reproductive Sciences , University of Toronto , Toronto , Canada
| | - Robert F Casper
- a Department of Obstetrics and Gynecology, TRIO Fertility, Toronto and Division of Reproductive Sciences , University of Toronto , Toronto , Canada
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Hentzen JEKR, Verschoor MA, Lemmers M, Ankum WM, Mol BWJ, van Wely M. Factors influencing women's preferences for subsequent management in the event of incomplete evacuation of the uterus after misoprostol treatment for miscarriage. Hum Reprod 2018; 32:1674-1683. [PMID: 28575402 DOI: 10.1093/humrep/dex216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 05/18/2017] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION What affects women's treatment preferences in the management of an incomplete evacuation of the uterus after misoprostol treatment for a first-trimester miscarriage? SUMMARY ANSWER Women's treatment preferences in the management of an incomplete evacuation of the uterus after misoprostol treatment for miscarriage are most strongly influenced by 'the risk of a reduced fertility' followed by 'the probability of success'. WHAT IS KNOWN ALREADY Available treatment options in miscarriage are surgical, medical or expectant management. Treatment with misoprostol leads to an incomplete evacuation of the uterus and additional surgical treatment in 20-50% of women. To our knowledge, women's preferences for subsequent treatment of an incomplete evacuation of the uterus after misoprostol treatment for miscarriage have not been studied yet. STUDY DESIGN, SIZE, DURATION Between April 2014 and January 2015, we conducted a prospective nationwide multicentre discrete-choice experiment (DCE). DCEs have become the most frequently applied approach for studying patient preferences in health care. In our DCE, which considerers five attributes, a target sample size was calculated including 20 patients per attribute for the main analysis. We intended to include 25% more patients, i.e. a total of 125 thus enabling us to assess heterogeneity of treatment choices. PARTICIPANTS/MATERIALS, SETTING, METHODS All women visiting the outpatient clinic with first-trimester miscarriage or incomplete miscarriage were invited to participate in the study. Women under 18 years of age, women who were unable to understand the Dutch questionnaire or women who already had received a treatment for the current miscarriage were excluded. Women's preferences were assessed using a DCE. A literature review, expert opinions and interviews with women from the general population were used to define relevant treatment characteristics. Five attributes were selected: (i) certainty about the duration of convalescence; (ii) number of days of bleeding after treatment; (iii) probability of success (empty uterus after treatment); (iv) risk of reduced fertility and (v) risk of complications requiring more time or readmission to hospital. Fourteen scenarios using these attributes were selected in the DCE. Each of these scenarios presented two treatment options, while treatment characteristics varied between the 14 scenarios. For each scenario, respondents were asked to choose the preferred treatment option. The importance of each attribute was analysed, and preference heterogeneity was investigated through latent-class analysis. MAIN RESULTS AND THE ROLE OF CHANCE One hundred and eighty-six women were included of whom 128 completed the DCE (69% response rate). The two attributes with the greatest effect on their preference were, probability of success and risk of reduced fertility. The latent-class analysis revealed two subgroups of patients with different preference patterns. Forty per cent of women were more influenced by treatment success and 59% were more influenced by risk. LIMITATIONS, REASONS FOR CAUTION Most women were highly educated and were of Dutch origin, which limits the generalizability of our findings. Women with lower education levels, other cultural backgrounds and/or different previous experiences may differ from our findings. WIDER IMPLICATIONS OF THE FINDINGS Patients preferences should be addressed when counselling patients with an incomplete miscarriage after misoprostol treatment. STUDY FUNDING/COMPETING INTEREST(S) This study was embedded in the MisoREST trial, and funded by ZonMw, a Dutch organization for Health Research and Development, project number 80-82310-97-12066. There were no conflicts of interests. TRIAL REGISTRATION NUMBER Dutch Trial Register NTR3310, http://www.trialregister.nl. TRIAL REGISTRATION DATE 27 February 2012. DATE OF FIRST PATIENT'S ENROLMENT 12 June 2012.
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Affiliation(s)
- Judith E K R Hentzen
- Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22770, 1100 DE, Amsterdam, The Netherlands
| | - Marianne A Verschoor
- Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22770, 1100 DE, Amsterdam, The Netherlands
| | - Marike Lemmers
- Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22770, 1100 DE, Amsterdam, The Netherlands
| | - Willem M Ankum
- Department of Obstetrics and Gynaecology, Academic Medical Center, PO Box 22770, 1100 DE, Amsterdam, The Netherlands
| | - Ben Willem J Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 55 King William Road, SA 5006 North Adelaide, Australia.,The South Australian Health and Medical Research Institute, North Terrace, SA 5000 Adelaide, Australia
| | - Madelon van Wely
- Centre of Reproductive Medicine, Academic Medical Center-University, PO Box 22770, 1100 DE Amsterdam, The Netherlands
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The Use of Manual Vacuum Aspiration in the Treatment of Incomplete Abortions: A Descriptive Study from Three Public Hospitals in Malawi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020370. [PMID: 29466308 PMCID: PMC5858439 DOI: 10.3390/ijerph15020370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/14/2018] [Accepted: 02/19/2018] [Indexed: 11/17/2022]
Abstract
Malawi has a high maternal mortality rate, of which unsafe abortion is a major cause. About 140,000 induced abortions are estimated every year, despite there being a restrictive abortion law in place. This leads to complications, such as incomplete abortions, which need to be treated to avoid further harm. Although manual vacuum aspiration (MVA) is a safe and cheap method of evacuating the uterus, the most commonly used method in Malawi is curettage. Medical treatment is used sparingly in the country, and the Ministry of Health has been trying to increase the use of MVA. The aim of this study was to investigate the treatment of incomplete abortions in three public hospitals in Southern Malawi during a three-year period. All medical files from the female/gynecological wards from 2013 to 2015 were reviewed. In total, information on obstetric history, demographics, and treatment were collected from 7270 women who had been treated for incomplete abortions. The overall use of MVA at the three hospitals during the study period was 11.4% (95% CI, 10.7-12.1). However, there was a major increase in MVA application at one District Hospital. Why there was only one successful hospital in this study is unclear, but may be due to more training and dedicated leadership at this particular hospital. Either way, the use of MVA in the treatment of incomplete abortions continues to be low in Malawi, despite recommendations from the World Health Organization (WHO) and the Malawi Ministry of Health.
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Dunford A, Fyfe R. Combination therapy with mifepristone and misoprostol for the management of first trimester miscarriage: Improved success. Aust N Z J Obstet Gynaecol 2017; 58:438-442. [DOI: 10.1111/ajo.12747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Angela Dunford
- Division of Obstetrics and Gynaecology; John Hunter Hospital; Newcastle NSW Australia
- Department of Gynaecology; The Royal Children's Hospital Melbourne; Vic Australia
| | - Rina Fyfe
- Division of Obstetrics and Gynaecology; John Hunter Hospital; Newcastle NSW Australia
- Maternal and Fetal Medicine Unit; Royal Prince Alfred Hospital; Sydney NSW Australia
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Le Gouic S, Lavoué V, Mimouni M, Levêque J, Huchon C. Evaluation of adherence to French clinical practice guidelines in the management of pregnancy loss issued by the French College of Obstetricians and Gynecologists, one year after publication: A vignette-based study. J Gynecol Obstet Hum Reprod 2017; 46:393-398. [DOI: 10.1016/j.jogoh.2017.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 03/15/2017] [Accepted: 03/23/2017] [Indexed: 12/16/2022]
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Petersen SG, Perkins AR, Gibbons KS, Bertolone JI, Mahomed K. Utility of βhCG monitoring in the follow-up of medical management of miscarriage. Aust N Z J Obstet Gynaecol 2017; 57:358-365. [PMID: 28345139 DOI: 10.1111/ajo.12607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/18/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the percentage change in total βeta-unit human chorionic gonadotropin (βhCG) levels (%ΔβhCG) in the prediction of treatment outcomes following intravaginal misoprostol for missed miscarriage before 13 weeks. METHODS A secondary analysis of a randomised controlled study of medical management of miscarriage was performed. Total βhCG levels were collected before misoprostol (baseline) and after a planned seven day interval (follow-up), when a transvaginal ultrasound (TVUS) reported a gestational sac as present or not. If no sac at TVUS, surgery was indicated on clinical criteria. %ΔβhCG ((baseline βhCG - follow-up βhCG)/baseline βhCG × 100) was evaluated in the prediction of a sac at TVUS and surgery on clinical criteria. RESULTS %ΔβhCG was calculated for cases with βhCG levels within two days of misoprostol and TVUS; calculation interval determined case number. The median %ΔβhCG for 24 cases with a persistent sac (6-9 day interval) was significantly lower than for 145 with no sac (58.75% (interquartile range (IQR): 37.59-76.69; maximum 86.54) vs 97.65% (IQR: 95.44-98.43); P < 0.0001). The median %ΔβhCG for eight cases needing surgery on clinical criteria (5-9 day interval) was significantly lower than for 140 cases with no sac not needing surgery (79.68% (IQR: 64.63-91.15; maximum 94.06) vs 97.68% (IQR: 95.61-98.50); P < 0.0001). The area under the receiver-operator curve was 0.975 for prediction of a persistent sac and 0.944 for prediction of surgery on clinical criteria, respectively. %ΔβhCG > 87% predicted no sac at TVUS. %ΔβhCG > 94.5% predicted no surgery on clinical criteria. CONCLUSION %ΔβhCG calculation over one week reliably predicted treatment outcomes after medical management of missed miscarriage.
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Affiliation(s)
- Scott G Petersen
- Department of Obstetrics and Gynaecology, Mater Mother's Hospital, Brisbane, Queensland, Australia.,Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
| | - Anneliese R Perkins
- Department of Obstetrics and Gynaecology, Mater Mother's Hospital, Brisbane, Queensland, Australia
| | - Kristen S Gibbons
- Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
| | - Julia I Bertolone
- Department of Obstetrics and Gynaecology, Mater Mother's Hospital, Brisbane, Queensland, Australia
| | - Kassam Mahomed
- Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
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Petracchi F, Paez C, Igarzabal L. Cost-effectiveness of cytogenetic evaluation of products of conception by chorionic villus sampling in recurrent miscarriage. Prenat Diagn 2017; 37:282-288. [DOI: 10.1002/pd.5005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/23/2016] [Accepted: 01/03/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Florencia Petracchi
- Centro de Educación Médica en Investigaciones Clínicas (CEMIC); Instituto Universitario - Department of Obstetrics and Gynecology; Genetic Unit, Galvan 4102, Buenos Aires Buenos Aires 1425 Argentina
| | - Cecilia Paez
- Centro de Educación Médica en Investigaciones Clínicas (CEMIC); Instituto Universitario - Department of Obstetrics and Gynecology; Genetic Unit, Galvan 4102, Buenos Aires Buenos Aires 1425 Argentina
| | - Laura Igarzabal
- Centro de Educación Médica en Investigaciones Clínicas (CEMIC); Instituto Universitario - Department of Obstetrics and Gynecology; Genetic Unit, Galvan 4102, Buenos Aires Buenos Aires 1425 Argentina
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Prevention of nausea and vomiting during termination of pregnancy. Int J Gynaecol Obstet 2016; 111:3-7. [DOI: 10.1016/j.ijgo.2010.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 05/06/2010] [Accepted: 05/27/2010] [Indexed: 11/22/2022]
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Colleselli V, Nell T, Bartosik T, Brunner C, Ciresa-Koenig A, Wildt L, Marth C, Seeber B. Marked improvement in the success rate of medical management of early pregnancy failure following the implementation of a novel institutional protocol and treatment guidelines: a follow-up study. Arch Gynecol Obstet 2016; 294:1265-1272. [PMID: 27554492 PMCID: PMC5071363 DOI: 10.1007/s00404-016-4179-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 08/09/2016] [Indexed: 11/30/2022]
Abstract
Purpose To analyze the success rate, time to passage of tissue and subjective patient experience of a newly implemented protocol for medical management of early pregnancy failure (EPF) over a 2-year period. Methods A retrospective chart review of all patients with early pregnancy failure primarily opting for medical management was performed. 200 mg mifepristone were administered orally, followed by a single vaginal dose of 800 mcg misoprostol after 36–48 h. We followed-up with our patients using a written questionnaire. Results 167 women were included in the present study. We observed an overall success rate of 92 %, defined as no need for surgical management after medication administration. We could not identify predictive values for success in a multivariate regression analysis. Most patients (84 %) passed tissue within 6 h after misoprostol administration. The protocol was well tolerated with a low incidence of side effects. Pain was managed well with sufficient analgesics. Responders to the questionnaire felt adequately informed prior to treatment and rated their overall experience as positive. Conclusion The adaption of the institutional medical protocol resulted in a marked improvement of success rate when compared to the previously used protocol (92 vs. 61 %). We credit this increase to the adjusted medication schema as well as to targeted physician education on the expected course and interpretation of outcome measures. Our results underscore that the medical management of EPF is a safe and effective alternative to surgical evacuation in the clinical setting.
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Affiliation(s)
- V Colleselli
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - T Nell
- Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - T Bartosik
- Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - C Brunner
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - A Ciresa-Koenig
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - L Wildt
- Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - C Marth
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - B Seeber
- Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Marwah S, Gupta S, Batra NP, Bhasin V, Sarna V, Kaur N. A Comparative Study to Evaluate the Efficacy of Vaginal vs Oral Prostaglandin E1 Analogue (Misoprostol) in Management of First Trimester Missed Abortion. J Clin Diagn Res 2016; 10:QC14-8. [PMID: 27437309 PMCID: PMC4948485 DOI: 10.7860/jcdr/2016/18178.7891] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/02/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Missed miscarriages, occurring in upto 15% of all clinically recognized pregnancies are a cause of concern for the patients. Though many researchers in the past have compared the surgical and medical approaches in management of such patients, only a few have executed an appraisal of two routes of misoprostol at equal dosages in treatment of first trimester missed miscarriages. AIM To compare the efficacy of misoprostol by vaginal and oral route, for the management of first trimester missed abortion; and to recognize the utility of misoprostol for cervical dilation prior to any surgical termination of pregnancy. MATERIALS AND METHODS A randomized prospective trial, comparing the efficacy of misoprostol, by vaginal and oral routes, for termination of first trimester missed abortion was conducted in the Department of Obstetrics and Gynecology, Government Multi-Specialty Hospital, Chandigarh over one year. Hundred subjects satisfying the inclusion criteria from 213 consecutive women presenting to the institute with first trimester missed abortion were hospitalized. The study participants were randomly assigned to one of the two treatment groups, using sequentially numbered envelopes, to receive 400mcg misoprostol vaginally or orally to a maximum of three doses six hours apart, and outcome documented. Patients were followed up on Day 14 and 6 weeks after discharge. Primary outcome evaluated was drug-induced complete expulsion of Products of Conception (POCs). Secondary outcomes measured were induction expulsion interval, number of doses required, classification of failures, cervical canal permeability in women requiring surgical evacuation, side effects, hemoglobin drop, duration and amount of post-abortal bleeding, time of resumption of menses, experience with side effects, patient satisfaction and acceptability to treatment. RESULTS Both routes were highly effective (vaginal=92%, oral= 74%, p=0.032), safe and acceptable with tolerable side effects. The mean time to expulsion was longer (13.24hrs) in the oral than vaginal group (10.87hrs). All 4 unsuccessful cases in vaginal group and 12 of 13 in oral group had permeable cervices prior to surgical evacuation. Most women labeled the side effects as tolerable in both the groups. Overall acceptance rate to treatment was high in both the groups A and B (76% and 70%). CONCLUSION Vaginal misoprostol is more effective than oral misoprostol for first trimester missed abortion.
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Affiliation(s)
- Sheeba Marwah
- Senior Resident, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Supriya Gupta
- Senior Medical Officer, Department of Obstetrics and Gynaecology, Government Multi Speciality Hospital, Sector-16, Chandigarh, India
| | - Neera Parothi Batra
- Senior Medical Officer and Head of Department, Department of Obstetrics and Gynaecology, Government Multi speciality Hospital, Sector-16, Chandigarh, India
| | - Vidhu Bhasin
- Ex-Senior Medical Officer, Department of Obstetrics and Gynaecology, Government Multi Speciality Hospital, Sector-16, Chandigarh, India
| | - Veena Sarna
- Ex-Senior Medical Officer, Department of Obstetrics and Gynaecology, Government Multi Speciality Hospital, Sector-16, Chandigarh, India
| | - Nirlep Kaur
- Senior Medical Officer and Medical Superintendant, Government Multi Speciality Hospital, Sector-16, Chandigarh, India
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Tamir R, Allouche S, Weissman A, Haikin Herzberger E, Oberman-Farhi S, Shalom-Paz E, Shulman A, Wiser A. The effect of medical versus surgical treatment of spontaneous miscarriage on subsequent in vitro fertilization cycles. Gynecol Endocrinol 2016; 32:231-3. [PMID: 26486224 DOI: 10.3109/09513590.2015.1110693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effect of dilation and curettage (D&C) and misoprostol as treatments for spontaneous miscarriage (SM) on in vitro fertilization (IVF) parameters in the subsequent IVF cycle. DESIGN Multicenter, retrospective, cohort study. Women treated for SM after IVF treatment with D&C or misoprostol and underwent a subsequent IVF cycle was included. The main outcome measures were ovarian response, endometrial thickness and pregnancy rate in the subsequent IVF cycle after MA. RESULTS Among 73 patients with miscarriage, 41 had D&C and 32 were given misoprostol. Baseline serum follicle stimulating hormone (FSH) levels and ovarian responses before and after treatment of miscarriage were comparable. No significant differences were observed between the D&C and the misoprostol groups in basal FSH levels, endometrial thickness and parameters of ovarian response in the subsequent IVF cycle. CONCLUSION D&C and misoprostol are both effective treatments for IVF patients with miscarriage, without an adverse effect on subsequent IVF treatment outcome.
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Affiliation(s)
- Rina Tamir
- a IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Sarit Allouche
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
- c IVF Unit, Department of Obstetrics and Gynecology Wolfson Medical Center , Holon , Israel
| | - Ariel Weissman
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
- c IVF Unit, Department of Obstetrics and Gynecology Wolfson Medical Center , Holon , Israel
| | - Einat Haikin Herzberger
- a IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Suzi Oberman-Farhi
- d IVF Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center , Hadera , Israel , and
- e Faculty of Medicine , Technion-Israel Institute of Technology , Haifa , Israel
| | - Einat Shalom-Paz
- d IVF Unit, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center , Hadera , Israel , and
- e Faculty of Medicine , Technion-Israel Institute of Technology , Haifa , Israel
| | - Adrian Shulman
- a IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Amir Wiser
- a IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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Lavecchia M, Abenhaim HA. Effect of Menstrual Age on Failure of Medical Management in Women With Early Pregnancy Loss. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:617-623. [DOI: 10.1016/s1701-2163(15)30199-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Marret H, Simon E, Beucher G, Dreyfus M, Gaudineau A, Vayssière C, Lesavre M, Pluchon M, Winer N, Fernandez H, Aubert J, Bejan-Angoulvant T, Jonville-Bera A, Clouqueur E, Houfflin-Debarge V, Garrigue A, Pierre F. Overview and expert assessment of off-label use of misoprostol in obstetrics and gynaecology: review and report by the Collège national des gynécologues obstétriciens français. Eur J Obstet Gynecol Reprod Biol 2015; 187:80-4. [DOI: 10.1016/j.ejogrb.2015.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/26/2014] [Accepted: 01/23/2015] [Indexed: 11/29/2022]
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Dalton VK, Liang A, Hutton DW, Zochowski MK, Fendrick AM. Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss. Am J Obstet Gynecol 2015; 212:177.e1-6. [PMID: 25174796 DOI: 10.1016/j.ajog.2014.08.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/08/2014] [Accepted: 08/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of this study was to estimate the economic consequences of expanding options for early pregnancy loss (EPL) treatment beyond expectant management and operating room surgical evacuation (usual care). STUDY DESIGN We constructed a decision model using a hypothetical cohort of women undergoing EPL management within a 30 day horizon. Treatment options under the usual care arm include expectant management and surgical uterine evacuation in an operating room (OR). Treatment options under the expanded care arm included all evidence-based safe and effective treatment options for EPL: expectant management, misoprostol treatment, surgical uterine evacuation in an office setting, and surgical uterine evacuation in an OR. Probabilities of entering various treatment pathways were based on previously published observational studies. RESULTS The cost per case was US $241.29 lower for women undergoing treatment in the expanded care model as compared with the usual care model (US $1033.29 per case vs US $1274.58 per case, expanded care and usual care, respectively). The model was the most sensitive to the failure rate of the expectant management arm, the cost of the OR surgical procedure, the proportion of women undergoing an OR surgical procedure under usual care, and the additional cost per patient associated with implementing and using the expanded care model. CONCLUSION This study demonstrates that expanding women's treatment options for EPL beyond what is typically available can result in lower direct medical expenditures.
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Beucher G, Dolley P, Stewart Z, Lavoué V, Deffieux X, Dreyfus M. Obtention de la vacuité utérine dans le cadre d’une perte de grossesse. ACTA ACUST UNITED AC 2014; 43:794-811. [DOI: 10.1016/j.jgyn.2014.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Beucher G, Dolley P, Stewart Z, Carles G, Dreyfus M. Fausses couches du premier trimestre : bénéfices et risques des alternatives thérapeutiques. ACTA ACUST UNITED AC 2014; 42:608-21. [DOI: 10.1016/j.gyobfe.2014.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 06/06/2014] [Indexed: 10/24/2022]
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Bord I, Gdalevich M, Nahum R, Meltcer S, Anteby EY, Orvieto R. Misoprostol treatment for early pregnancy failure does not impair future fertility. Gynecol Endocrinol 2014; 30:316-9. [PMID: 24455996 DOI: 10.3109/09513590.2013.879855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To examine whether misoprostol treatment for first trimester missed abortion affects future fertility. PATIENTS AND METHODS In a historical prospective approach, we analyzed our database for patients treated with misoprostol. All eligible patients underwent an interview according to a questionnaire, which includes their demographic characteristics, obstetric, gynecologic and infertility history. They were asked about the side effects, intention and subsequent ability to conceive. Their future pregnancy rates were calculated and compared to the acceptable figures in the literature. RESULTS The infertility rates among our patients were similar to those reported in the general population. Pregnancy rates 2 years after treatment were similar to the previously published reports, except for lower rates during the first three months post-treatment. Although no between-group differences were observed in the subsequent pregnancy rates, 2 years following misoprostol treatment in ≤35 versus >35 years old patients, primi- versus multigravida and nulli- versus parous women, higher pregnancy rates were observed in patients ≤35 versus >35 years old, primi- versus multigravida and nulli- versus, parous, during the first 3 months following misoprostol treatment. CONCLUSION Misoprostol treatment, for women with first trimester missed abortion and favorable reproductive history, is an acceptable treatment with no detrimental effect on future fertility.
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Affiliation(s)
- Ilia Bord
- Department of Obstetrics and Gynecology, Barzilai Medical Center , Ashkelon , Israel and
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Nadarajah R, Quek YS, Kuppannan K, Woon SY, Jeganathan R. A randomised controlled trial of expectant management versus surgical evacuation of early pregnancy loss. Eur J Obstet Gynecol Reprod Biol 2014; 178:35-41. [PMID: 24813099 DOI: 10.1016/j.ejogrb.2014.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 02/02/2014] [Accepted: 02/08/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To show whether a clinically significant difference in success rates exists between expectant and surgical management of early pregnancy loss. STUDY DESIGN Randomised controlled trial comparing expectant versus surgical management of early pregnancy loss over a 1-year period from 1st January to 31st December 2009 at Sultanah Aminah Hospital, Johor Bahru. Pregnant women with missed or incomplete miscarriages at gestations up to 14 weeks were recruited in this study. The success rate in the surgical group was measured as curettage performed without any complications during or after the procedure, while the success rate in the expectant group was defined as complete spontaneous expulsion of products of conception within 6 weeks without any complication. RESULTS A total of 360 women were recruited and randomised to expectant or surgical management, with 180 women in each group. There was no statistically significant difference in the success rate between the groups and between the different types of miscarriage. With expectant management, 131 (74%) patients had a complete spontaneous expulsion of products of conception, of whom 106 (83%) women miscarried within 7 days. However, the rates of unplanned admissions (18.1%) and unplanned surgical evacuations (17.5%) in the expectant group were significantly higher than the rates (7.4% and 8% respectively) in the surgical group. The complications in both groups were similar.
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Affiliation(s)
- Ravichandran Nadarajah
- Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, 80100 Johor Bahru, Malaysia(1).
| | - Yek Song Quek
- Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, 80100 Johor Bahru, Malaysia(1)
| | - Kaliammah Kuppannan
- Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, 80100 Johor Bahru, Malaysia(1)
| | - Shu Yuan Woon
- Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, 80100 Johor Bahru, Malaysia(1)
| | - Ravichandran Jeganathan
- Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, 80100 Johor Bahru, Malaysia(1)
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Beucher G, Dolley P, Carles G, Salaun F, Asselin I, Dreyfus M. Misoprostol : utilisation hors AMM au premier trimestre de la grossesse (fausses couches spontanées, interruptions médicales et volontaires de grossesse). ACTA ACUST UNITED AC 2014; 43:123-45. [DOI: 10.1016/j.jgyn.2013.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Colleselli V, Schreiber CA, D'Costa E, Mangesius S, Wildt L, Seeber BE. Medical management of early pregnancy failure (EPF): a retrospective analysis of a combined protocol of mifepristone and misoprostol used in clinical practice. Arch Gynecol Obstet 2013; 289:1341-5. [PMID: 24305748 DOI: 10.1007/s00404-013-3105-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 11/18/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of a combined protocol of mifepristone and misoprostol in the management of early pregnancy failure (EPF) and the average time to expulsion of tissue and rate of side effects. METHODS Retrospective chart review of all consecutive women treated with primary medical management for EPF at our institution from 2006 to 2012. RESULTS 168 patients were included in the present study. The overall success rate, defined as the absence of the need for surgical intervention, was 61 % and did not differ by calendar year. There was no difference in success rate grouped by diagnosis [intrauterine embryonic/fetal demise (IUED/IUFD) vs. anembryonic gestation; p = 0.30] or gestational age (<9 or ≥9 weeks; p = 0.48). The success rate varied significantly according to the required dose of misoprostol, ≤800 or >800 μg (68 vs. 50 %, p = 0.029). Of the possible predictive factors of success, only the dose of misoprostol required was a significant independent negative predictor. Mean and median time to tissue expulsion after the first dose of misoprostol were 8.4 and 5.5 h, respectively. The incidence of side effects was low with no blood transfusions required. CONCLUSIONS The success rate in this study is markedly below published data. This can possibly be attributed to retrospective study design, allowing for physician subjectivity and patients' wishes in the absence of strict study requirements. The protocol was well tolerated with a paucity of side effects. We make suggestions for enhancing success rates in the clinical setting by optimizing medication protocols, establishing precise treatment guidelines and training physicians in the accurate interpretation of treatment outcomes.
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Affiliation(s)
- Valeria Colleselli
- Department of Gynecologic Endocrinology and Reproductive Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
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Expectant versus surgical management of first-trimester miscarriage: a randomised controlled study. Arch Gynecol Obstet 2013; 289:1011-5. [PMID: 24240972 DOI: 10.1007/s00404-013-3088-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The aim of this study is to compare the efficacy and safety of expectant management with surgical management of first-trimester miscarriage. METHODS This randomised prospective study was conducted in the Gynaecology Department at University of Saarland Hospital, Germany between February 2011 and April 2012. A total of 234 women were recruited following diagnosis of the first-trimester incomplete or missed miscarriage and randomised into two groups: 109 women were randomised to expectant management (group I), and 125 women to surgical management (groupII). All women were examined clinically and sonographically during the follow-up appointments at weekly intervals for up to 4 weeks as appropriate. The outcome measures were: efficacy, short-term complications and duration of vaginal bleeding and pain. RESULTS Of 234 eligible women, 17 were lost to follow-up, and the remaining 217 women were analysed. The baseline characteristics were similar in both groups. The total success rate at 4 weeks was lower for expectant than for surgical management (81.4 vs 95.7 %; P = 0.0029). The type of miscarriage was a significant factor affecting the success rate. For missed miscarriage, the success rates for expectant versus surgical management were 75 and 93.8 %, respectively. For women with incomplete miscarriage, the rates were 90.5 and 98 %. No differences were found in the number of emergency curettages between the two study groups. The duration of bleeding was significantly more in the expectant than the surgical management (mean 11 vs 7 days; P < 0.0001). The duration of pain was also more in the expectant than the surgical group (mean 8.1 vs 5.5 days; P < 0.0001). The total complication rates were similar in both groups (expectant 5.9 % vs surgical group 6.1 %; P = 0.2479). However, the pelvic infection was significantly lower in the expectant than the surgical group (1.9 vs 3.5 %, respectively; P = 0.0146). CONCLUSION Expectant management of clinically stable women with first-trimester miscarriage is safe and effective and avoids the need for surgery and the subsequent risk of anaesthesia in about 81.4 % of cases, and has lower pelvic infection rate than surgical curettage. However, surgical management is more successful, and with a shorter duration of bleeding and pain. Therefore, the patient's preference should be considered in the counselling process.
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Petersen SG, Perkins AR, Gibbons KS, Bertolone JI, Mahomed K. The medical management of missed miscarriage: outcomes from a prospective, single‐centre, Australian cohort. Med J Aust 2013; 199:341-6. [DOI: 10.5694/mja12.11813] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 05/30/2013] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | - Kassam Mahomed
- Mater Medical Research Institute, Brisbane, QLD
- Ipswich Hospital, Brisbane, QLD
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Sellmyer MA, Desser TS, Maturen KE, Jeffrey RB, Kamaya A. Physiologic, Histologic, and Imaging Features of Retained Products of Conception. Radiographics 2013; 33:781-96. [DOI: 10.1148/rg.333125177] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kong GWS, Lok IH, Yiu AKW, Hui ASY, Lai BPY, Chung TKH. Clinical and psychological impact after surgical, medical or expectant management of first-trimester miscarriage - a randomised controlled trial. Aust N Z J Obstet Gynaecol 2013; 53:170-7. [PMID: 23488984 DOI: 10.1111/ajo.12064] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 01/23/2013] [Indexed: 01/17/2023]
Affiliation(s)
- Grace Wing Shan Kong
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Prince of Wales Hospital; Shatin; Hong Kong; China
| | - Ingrid Hung Lok
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Prince of Wales Hospital; Shatin; Hong Kong; China
| | - Alice Ka Wah Yiu
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Prince of Wales Hospital; Shatin; Hong Kong; China
| | - Annie Shuk Yi Hui
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Prince of Wales Hospital; Shatin; Hong Kong; China
| | - Beatrice Pui Yee Lai
- Division of Social Science; The Hong Kong University of Science and Technology; Hong Kong; China
| | - Tony Kwok Hung Chung
- Department of Obstetrics and Gynaecology; The Chinese University of Hong Kong; Prince of Wales Hospital; Shatin; Hong Kong; China
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Reif P, Tappauf C, Panzitt T, Haas J, Lang U, Klaritsch P. Efficacy of misoprostol in relation to uterine position in the treatment of early pregnancy failure. Int J Gynaecol Obstet 2013; 121:137-40. [DOI: 10.1016/j.ijgo.2012.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 11/08/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
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