How should success be defined when attempting medical resolution of first-trimester missed abortion?

Autor: Nuno Montenegro, Diogo Ayres-de-Campos, Ana Reynolds, Maria Antónia Costa
Rok vydání: 2005
Předmět:
Zdroj: European Journal of Obstetrics & Gynecology and Reproductive Biology. 118:71-76
ISSN: 0301-2115
DOI: 10.1016/j.ejogrb.2004.06.031
Popis: Objectives: There is currently no consensus on how success should be defined after medical management of first-trimester missed abortion. The aim of this study was to determine the transvaginal ultrasound criterion associated with highest success rate and, at the same time, lowest long-term complications. Design: Prospective observational study of consecutively enrolled patients. Setting: A tertiary care university hospital in northern Portugal. Participants : Forty-four women submitted to medical management of first-trimester missed abortion using a regimen of vaginal misoprostol, with histologically confirmed conception products passed vaginally. A transvaginal ultrasound scan was performed by an experienced sonographer in the morning after treatment, to characterise uterine content. Patients were provided with a chart for daily registration of axillary temperature, vaginal bleeding and lower abdominal pain. Transvaginal ultrasound was repeated 2–3 weeks later, and again after the following menses. Main outcome measures: Success rates of medical management when post-treatment transvaginal ultrasound criteria for subsequent expectant management were: absence of intra-uterine sac, largest anteroposterior diameter of hyperechogenic content, and maximum area of hyperechogenic intra-uterine content in a sagittal view. Self-reported duration of vaginal bleeding and abdominal pain after medical treatment. Results: Success rate was 86% (38/44) when absence of gestational sac on the 12h transvaginal ultrasound was used as the main criterion for subsequent expectant management and there was no need for further intervention. The success rate using the ultrasound criterion anteroposterior diameter ≤15mm was 51% (22/43), and with maximum sagittal plane area under 7.5cm 2 , 72% (31/43). Mean duration of vaginal haemorrhage was 9 days (minimum 2 days, maximum 14 days) and of lower abdominal pain 6 days (minimum 0 days, maximum 14 days). No patient recorded an axillary temperature exceeding 37°C. No apparent relationship between the size of ultrasound-estimated intra-uterine content and duration of symptoms was observed. Conclusions: Absence of gestational sac on transvaginal ultrasound should be the criterion used to document success after medical management of first-trimester missed abortion, as it is associated with the highest short and long-term success rates, as well as mild and self-limited symptoms in the days following treatment.
Databáze: OpenAIRE