Society of Family Planning Clinical Recommendation: Medication management for early pregnancy loss.

Autor: Tarleton JL; Planned Parenthood South Atlantic, Raleigh, NC, USA and McLeod Regional Medical Center, Florence, SC, USA. Electronic address: jessica.tarleton.md@gmail.com., Benson LS; University of Washington Department of Obstetrics and Gynecology, 1959 NE Pacific St, Box 356460, Seattle, WA 98005, USA. Electronic address: lsbenson@uw.edu., Moayedi G; Pegasus Health Justice Center, Dallas, TX, 75207, USA., Trevino J; Washington University, St. Louis, MO, USA. Electronic address: jayme@wustl.edu., Beasley A; Planned Parenthood South Atlantic, Raleigh, NC, USA and McLeod Regional Medical Center, Florence, SC, USA; University of Washington Department of Obstetrics and Gynecology, 1959 NE Pacific St, Box 356460, Seattle, WA 98005, USA; Pegasus Health Justice Center, Dallas, TX, 75207, USA; Washington University, St. Louis, MO, USA., Boos E; Planned Parenthood South Atlantic, Raleigh, NC, USA and McLeod Regional Medical Center, Florence, SC, USA; University of Washington Department of Obstetrics and Gynecology, 1959 NE Pacific St, Box 356460, Seattle, WA 98005, USA; Pegasus Health Justice Center, Dallas, TX, 75207, USA; Washington University, St. Louis, MO, USA.
Jazyk: angličtina
Zdroj: Contraception [Contraception] 2024 Dec 20, pp. 110805. Date of Electronic Publication: 2024 Dec 20.
DOI: 10.1016/j.contraception.2024.110805
Abstrakt: Early pregnancy loss (EPL), also known as miscarriage or spontaneous abortion, makes up 15-20% of all clinically recognized pregnancies. EPL is a broad term that includes intrauterine pregnancies (IUPs) with findings that suggest the pregnancy may not progress or definitely will not progress; pregnancies with a gestational sac (GS) in the lower endometrial cavity or endocervical canal in the process of expulsion; residual pregnancy tissue or persistent GS; and complete passage of the GS without residual tissue. This document addresses medication management of EPL in which the complete passage of the GS has not yet occurred, including pregnancies concerning for and diagnostic of EPL (sometimes called "missed abortion") and EPL in progress. We recommend that patients experiencing EPL have equal access to all available treatment options, including expectant, medication, and procedural management, when urgent treatment is not necessary (GRADE 1A). We recommend a patient-centered approach that uses shared decision-making to diagnose EPL through ultrasound, serial quantitative hCG measurements, or symptoms, depending on the patient's desire for a definitive diagnosis (GRADE 1C). We suggest a shared decision-making approach for continuing expectant management of EPL up to eight weeks after diagnosis in the absence of medical complications or symptoms requiring urgent intervention (GRADE 2C). Given the available evidence, medically stable patients who select expectant management should be counseled that they may decide to change to medication or procedural management at any point during expectant management. We suggest against Rh testing and Rh immunoglobulin administration before 12 weeks of gestation for patients undergoing medication management of EPL (GRADE 2B). We recommend a combined regimen of mifepristone with misoprostol over misoprostol alone for medication management of EPL (GRADE 1A). We suggest the use of a combination of mifepristone 200 mg orally followed 7-48 hours later by misoprostol 800 mcg vaginally or buccally for medication management of EPL (GRADE 2A). We recommend misoprostol in two or more doses of 600-800 mcg sublingually or vaginally at intervals of at least three hours when used alone for medication management of EPL (GRADE 1B). We suggest ibuprofen 800 mg orally for pain control in medication management of EPL (GRADE 2A). The use of other nonsteroidal anti-inflammatory drugs and opioids in this setting is not supported by the EPL literature but may be reasonable on an individual basis. We suggest clinicians offer all patients confirmation of completed EPL, but in-person evaluation should not be required (GRADE 2B). We recommend against using endometrial thickness alone as a criterion for recommending additional intervention after medication management of EPL (GRADE 1B). We recommend institutions and clinicians make thorough efforts to obtain and maintain access to mifepristone in clinical settings where patients receive EPL care (GRADE 1C).
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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