Medical treatments for incomplete miscarriage

Kim, Caron; Barnard, Sharmani; Neilson, James P; Hickey, Martha; Vázquez, Juan C; Dou, Lixia

doi:10.1002/14651858.cd007223.pub4

Cited by 77 publications

(62 citation statements)

References 211 publications

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“…In the last few decades, an increase in the frequency of pharmacological management of spontaneous miscarriage, including missed miscarriage and empty gestational sac, has been observed in many medical centers [4][5][6]12]. The advantages of this option are obvious, as this method is non-invasive and well-accepted by patients, does not require anesthesia, and results in a lower percentage of short-and long-term complications in comparison to curettage [5,6,27,28].…”

Section: Discussionmentioning

confidence: 99%

“…When miscarriage is diagnosed, therapeutic decisions are made depending on the type of miscarriage, the presence and severity of clinical symptoms, as well as patient choice; the patient is informed about possible therapeutic options together with the advantages and disadvantages of each option [5][6][7][8]. Historically, a diagnosis of miscarriage resulted in immediate curettage of the uterine cavity in order to avoid complications associated with gestational tissues remaining in the uterine cavity such as hemorrhage, local or generalized infection, and proliferation of trophoblastic tissue leading to gestational trophoblastic disease [5,6]. In the literature, two methods of treatment are described.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the diagnostic value of histopathological examinations of miscarriage products after pharmacological induction of miscarriage and curettage

et al. 2019

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Objectives: For early miscarriage (pregnancy loss ≤ 12 weeks of gestation), two types of therapeutic treatment are offered (pharmacotherapy and curettage of the uterine cavity) depending on the presence and severity of clinical symptoms as well as patient choice. Our study aimed to assess the diagnostic value of the results of histopathological examinations of miscarriage products in relation to the administered treatments. Material and methods: 850 medical records from patients diagnosed with missed miscarriage or empty gestational sac were analyzed retrospectively. Patients underwent surgical treatment or pharmacotherapy. Inefficacy of pharmacotherapy resulted in subsequent curettage. The results of histopathology were evaluated for their diagnostic value and classified: subgroup 1-high value specimen (the studied specimen included fetal tissues, and villi), and subgroup 2-no-diagnosis (the studied specimen included maternal tissues, autolyzed tissues, blood clots). Data were compared with chi-squared test. Differences was considered significant at p < 0.05. Results: 1128 histopathological test results were analyzed; 569 (50.4%) were obtained during pharmacotherapy and 559 (49.6%) after curettage; out of the latter 497 after the initial pharmacotherapy and 62 after surgery. In the pharmacotherapy group, high value specimens comprised 231 cases (40.59%) while no diagnosis was obtained in 338 cases (59.4%). Considering specimens obtained in the course curettage, high value specimens were found in 364 cases (65.1%) while results that did not allow a diagnosis to be made were found in 195 cases (34.9%). Conclusions: Tissue specimens of high diagnostic value are obtained significantly more often during surgical treatment of miscarriage than during pharmacotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the diagnostic value of histopathological examinations of miscarriage products after pharmacological induction of miscarriage and curettage

et al. 2019

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“…11,12 Our estimates of miscarriage treatment-related events, including the more than 6% retained products of conception, are in the range of other estimates. [24][25][26][27][28][29][30][31] The rates of miscarriage treatment-related events are notably higher than published rates of abortion-related events. 9,10,12,32,33 One explanation is that there have been both government sponsored and professional association sponsored clinical quality improvement initiatives for abortion for more than 40 years, [33][34][35] meaning that considerable attention has been brought to ensuring and improving the safety of abortion care.…”

Section: Commentmentioning

confidence: 99%

“…There were more events after medication treatment in office-based settings than hospitals and ASCs, although still within the range of published estimates. [24][25][26][27][28][29][30][31] As medication treatment does not involve procedures performed in facilities, these findings may reflect how other aspects of care, such as patient education, follow-up, and treatments provided at follow-up, may vary across facility types.…”

Section: Commentmentioning

confidence: 99%

Miscarriage Treatment–Related Morbidities and Adverse Events in Hospitals, Ambulatory Surgery Centers, and Office-Based Settings

et al. 2018

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Objective: To examine whether miscarriage treatment-related morbidities and adverse events vary across facility types. Methods: A retrospective cohort study compared miscarriage treatmentrelated morbidities and adverse events across hospitals, ambulatory surgery centers (ASCs), and office-based settings. Data on women who had miscarriage treatment between 2011-2014 and were continuously enrolled in their insurance plan for at least one year prior to and at least six weeks after treatment were obtained from a large national private insurance claims database. The main outcome was miscarriage treatment-related morbidities and adverse events occurring within six-weeks of miscarriage treatment. Secondary outcomes were major events and infections. Results: 97,374 miscarriage treatments met inclusion criteria. Most (75%) were provided in hospitals, 10% ASCs, and 15% office-based settings. 9.3% had miscarriage treatment-related events, 1.0% major events, and 1.5% infections. In adjusted analyses, there were fewer events in ASCs (6.5%) than office-based settings (9.4%) and hospitals (9.6%), but no significant difference between office-based settings and hospitals. There were no significant differences in major events between ASCs (0.7%) and office-based settings (0.8%), but more in hospitals (1.1%) than ASCs and office-based settings. There were fewer infections in ASCs (0.9%) than office-based settings (1.2%) and more in hospitals (1.6%) than ASCs and office-based settings. In analyses stratified by miscarriage treatment type, the difference 45 46 3 between ASCs and office-based settings was no longer significant for miscarriages treated with procedures. Conclusions: While there appear to be slightly more events in hospitals than ASCs or office-based settings, findings do not support limiting miscarriage treatment to particular settings.

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“…Complete evacuation rates after taking misoprostol were varied in different routes of administration or doses or both [30]. Though there is insufficient evidence to draw firm conclusion, combination of progesterone receptor modulator mifepristone with misoprostol could improve the evacuation rate [31].…”

Section: Incomplete Abortionmentioning

confidence: 99%

Interventions for Failed Family Planning

Chien¹,

Au²

2018

Family Planning

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Despite the introduction of family planning services in most areas of the world, failures of contraceptive use often lead to unplanned pregnancies. These women often resort to unsafe methods to end their pregnancies, which contributes to the fourth leading cause of maternal mortality worldwide. Demographic variables that may affect the intention to discontinue the pregnancies would be demonstrated. Pros and cons of different types of induced abortions would be presented and discussed. Programs integrating counseling for women after failed family planning for future comprehensive reproductive health care will be shown. The gap between women's reproductive desire to avoid pregnancy and altitude of contraceptive use may contribute to the prevalence of unintended pregnancy. Age, race/ethnicity, marital status, and socioeconomic characteristics should be considered in counseling women after failed family planning. Expanding the program that offers integrated abortion training would prepare more physicians to provide comprehensive care for family planning.

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Medical treatments for incomplete miscarriage

Cited by 77 publications

References 211 publications

Comparison of the diagnostic value of histopathological examinations of miscarriage products after pharmacological induction of miscarriage and curettage

Comparison of the diagnostic value of histopathological examinations of miscarriage products after pharmacological induction of miscarriage and curettage

Miscarriage Treatment–Related Morbidities and Adverse Events in Hospitals, Ambulatory Surgery Centers, and Office-Based Settings

Interventions for Failed Family Planning

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