Reproductive outcome after early miscarriage: comparing vaginal misoprostol treatment with expectant management in a planned secondary analysis of a randomized controlled trial
| Autor: | Lil Valentin, Ligita Jokubkiene, A. Fernlund, Povilas Sladkevicius |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Adult
medicine.medical_specialty media_common.quotation_subject Fertility law.invention Miscarriage Birth Intervals Randomized controlled trial Pregnancy law medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Watchful Waiting Reproductive History Misoprostol Randomized Controlled Trials as Topic media_common Abortifacient Agents Nonsteroidal Radiological and Ultrasound Technology Ectopic pregnancy Obstetrics business.industry Reproduction Medical record Obstetrics and Gynecology General Medicine medicine.disease Abortion Spontaneous Administration Intravaginal Treatment Outcome Reproductive Medicine Female Uterine Hemorrhage business Live birth medicine.drug |
| Zdroj: | Ultrasound in Obstetrics & Gynecology. 59:100-106 |
| ISSN: | 1469-0705 0960-7692 |
| DOI: | 10.1002/uog.24769 |
| Popis: | To compare the reproductive outcome after early miscarriage between women managed expectantly and those treated with vaginal misoprostol.This study was a planned secondary analysis of data collected prospectively in a randomized controlled trial comparing expectant management with vaginal misoprostol treatment (single dose of 800 µg) in women with early embryonic or anembryonic miscarriage and vaginal bleeding. The outcome measures were the number of women with a clinical pregnancy conceived within 14 months after complete miscarriage and the outcome of these pregnancies in terms of live birth, miscarriage, ectopic pregnancy and legal termination of pregnancy. The participants replied to a questionnaire sent by post covering their reproductive history ≤ 14 months after the index miscarriage was complete. Supplementary information and data for women who did not return their questionnaire were retrieved from medical records.Of 94 women randomized to misoprostol treatment and 95 allocated to expectant management, 94 and 90 women, respectively, were included for analysis. Information on reproductive outcome was available for 89/94 (95%) and 83/90 (92%) women, respectively. Complete miscarriage without surgical evacuation was achieved within 31 days in 85% (76/89) of the women in the misoprostol group and in 65% (54/83) of those managed expectantly. The proportion of women treated with surgical evacuation was 33% (27/83) in the expectant-management group vs 12% (11/89) in the misoprostol group. At 14 months after the index miscarriage was complete, 75% (67/89) of women treated with misoprostol and 75% (62/83) of those managed expectantly had achieved at least one clinical pregnancy, while 40% (36/89) and 35% (29/83), respectively, had had at least one live birth (mean difference, 5.5% (95% CI, -9.7 to 20.3%)). When considering the outcome of all pregnancies conceived within 14 months after the index miscarriage was complete, 63% (56/89) of women in the misoprostol group and 55% (46/83) of those in the expectant-management group delivered a live baby after a pregnancy (mean difference, 7.5% (95% CI, -7.9 to 22.4%)).Women with early miscarriage can be reassured that fertility is similar after misoprostol treatment and expectant management. © 2021 The Authors. Ultrasound in ObstetricsGynecology published by John WileySons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. |
| Databáze: | OpenAIRE |
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