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Cohen A, Gutman-Ido E, Karavani G, Albeck A, Rosenbloom JI, Shushan A, Chill HH. The association between history of retained placenta and success rate of misoprostol treatment for early pregnancy failure. BMC Womens Health 2023; 23:523. [PMID: 37794425 PMCID: PMC10552386 DOI: 10.1186/s12905-023-02666-9] [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: 06/02/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND To date, the association between retained placenta and treatment success rate of misoprostol for early pregnancy failure has yet to be evaluated. The aim of this study was to evaluate this association and further investigated the connection between medical, clinical and sonographic parameters and treatment success. METHODS We conducted a retrospective cohort study of women with early pregnancy failure treated with misoprostol from 2006 to 2021. The success rate of misoprostol treatment was compared between patients with history of retained placenta including women who underwent manual lysis of the placenta following delivery or patients who were found to have retained products of conception during their post-partum period (study group) and patients without such history (controls). Demographic, clinical, and sonographic characteristics as well as treatment outcomes were compared between the groups. RESULTS A total of 271 women were included in the study (34 women in the study group compared to 237 women in the control group). Two-hundred and thirty-three women (86.0%) presented with missed abortion, and 38 (14.0%) with blighted ovum. Success rates of misoprostol treatment were 61.8% and 78.5% for the study and control groups, respectively (p = 0.032). Univariate analysis performed comparing successful vs. failed misoprostol treatment showed advanced age, gravidity, parity and gestational sac size (mm) on TVUS were associated with higher misoprostol treatment failure rate. Following a multivariate logistic regression model these variables did not reach statistical significance. CONCLUSION Women who have an event of retained placenta following childbirth appear to have decreased success rate of treatment with misoprostol for early pregnancy failure. Larger studies are needed to confirm this finding.
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Affiliation(s)
- Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem, P.O.B. 12000, 91120, Israel.
| | - Einat Gutman-Ido
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem, P.O.B. 12000, 91120, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem, P.O.B. 12000, 91120, Israel
| | - Alon Albeck
- Department of Internal Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem, P.O.B. 12000, 91120, Israel
| | - Asher Shushan
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem, P.O.B. 12000, 91120, Israel
| | - Henry H Chill
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
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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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Fertility and obstetric outcomes after curettage versus expectant management in randomised and non-randomised women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage. Eur J Obstet Gynecol Reprod Biol 2017; 211:78-82. [PMID: 28199872 DOI: 10.1016/j.ejogrb.2017.01.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/24/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess fertility and obstetric outcomes in women treated with curettage or undergoing expectant management for an incomplete miscarriage after misoprostol treatment. STUDY DESIGN Between June 2012 and July 2014, we conducted a multicentre randomised clinical trial (RCT) with a parallel cohort study for non-randomised women, treated according to their preference. In the RCT 30 women were allocated curettage and 29 expectant management. In the cohort 197 women participated; 65 underwent curettage and 132 women underwent expectant management. Primary outcome was curation, defined as either an empty uterus on sonography at six weeks or an uneventful clinical follow-up. We used questionnaires to assess fertility and obstetric outcome of the first new pregnancy subsequent to study enrolment. RESULTS Curation was seen in 91/95 women treated with curettage (95.8%) versus 134/161 women managed expectantly (83.2%) (p=0.003). The response rate was 211/255 (82%). In 198 women pursuing a new pregnancy, conception rates were 92% (67/73) in the curettage group versus 96% (120/125) in the expectant management group (OR 0.96, 95% CI 0.89;1.03, p=0.34), with ongoing pregnancy rates of 87% (58/67) versus 78% (94/120), respectively (OR 1.12, 95% CI 0.99;1.28, p=0.226). Preterm birth rates were 1/46 in the curettage group versus 8/81 in the expectant management group (OR 0.22, 95% CI 0.03;1.71 P=0.15). Caesarean section rates were 23% and 24% for women in the curettage group and expectant management group respectively. CONCLUSION In women with an incomplete evacuation of the uterus after misoprostol treatment, curettage and expectant management does not lead to different fertility and pregnancy outcomes, as compared to expectant management.
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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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