Potential predictors for successful misoprostol treatment for early pregnancy failure: Clinical and color Doppler imaging study

Elkholi, Dina Gamal Eldeen Y.; Hefeda, Mohamed Mohamed

doi:10.1016/j.mefs.2014.08.001

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…Lower gestational age was significantly associated with success rate (increased gestational age decrease success rate). Our finding agree with another study showed that the lower gestational age the higher success rate of misoprostol [14] .…”

Section: Discussionsupporting

confidence: 93%

Misoprostol Versus Manual Vacuum Aspiration in Treatment of Missed Miscarriage in First Trimester

Allakany

2021

The Medical Journal of Cairo University

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Background: Manual vacuum aspiration (MVA) is a safe and effective technology for the treatment of missed miscarriage but it is not widely available and affordable in rural areas particularly in low resource countries. Misoprostol is an alternative to manual vacuum aspiration for the treatment of missed miscarriage. Aim of Study:The purpose of this study was to compare the effectiveness, patient satisfaction and hematocrit drop of misoprostol versus MVA to understand the potential role of misoprostol as a first line for treatment of first trimester missed miscarriage.Patients and Methods: A Randomized Controlled Trial was conducted from January 2020 to January 2021 at Mansoura University Maternity Hospital. Included 70 participants were randomized to treatment with either MVA or 800 µg vaginal misoprostol. The main outcome measures assessed at 1 week follow up were complete uterine evacuation, patient's acceptability and satisfaction.Results: There is no statistically significant difference between studied groups regarding success rate and mean patient satisfaction score immediately and after one week, 82.9% of misoprostol group and 94.3% of MVA group successes. The mean hemoglobin and hematocrit after treatment illustrated statistically significant lower mean value among misoprostol group than MVA group (10.07 & 10.91, respectively for Hb) and (30.75 & 33, respectively for hematocrit value). Hemoglobin drop for both groups illustrated no statistically significant difference between studied groups. There is statistically significant negative correlation between endometrial thickness/mm and satisfaction after one week among both group. Conclusion:Both misoprostol and MVA had high rates of satisfaction and complete uterine evacuation, which could ultimately reduce maternal complications from abortion. Medical treatment is as effective as surgical treatment of first trimester missed miscarriages.Recommendations: Although misoprostol is a very effective drug, the health care professional should have thorough knowledge of the dose, side effects, complications and con-

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Section: Discussionsupporting

confidence: 93%

Misoprostol Versus Manual Vacuum Aspiration in Treatment of Missed Miscarriage in First Trimester

Allakany

2021

The Medical Journal of Cairo University

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“…Another study concluded that women with active vaginal bleeding and/or abdominal colic in the 24 hours before misoprostol administration, nulliparas, and women with low blood flow in trophoblastic tissue were most likely to have complete miscarriage. 30 Unfortunately, Doppler studies were not performed on our participants.…”

Section: R E T R a C T E Dmentioning

confidence: 99%

Retracted: Misoprostol versus expectant management in women with incomplete first‐trimester miscarriage after failed primary misoprostol treatment: A randomized clinical trial

Ali

Emam

Abdel-Aleem

et al. 2021

Intl J Gynecology & Obste

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Objective To compare the effectiveness and safety of repeat misoprostol versus expectant management in women with first‐trimester incomplete miscarriage who have been initially treated with misoprostol. Methods The study was an open‐labeled randomized controlled trial including women with an incomplete first‐trimester miscarriage after administration of misoprostol. The participants were randomly assigned to vaginal misoprostol or expectant management using a computer‐generated table of random numbers. The primary outcome was the number of women with a complete miscarriage at 1 week. Results Eighty‐eight women (44 women in each group) were analyzed. The rate of complete miscarriage at 1 week was significantly higher in the misoprostol group than the expectant management group—29 (69.0%) versus 7 (16.7%) (P < 0.001), respectively. Women in the misoprostol group were more satisfied (7.00 ± 0.77 vs 4.57 ± 1.61, P < 0.001) but reported more pain (7.95 ± 1.85 vs 5.26 ± 1.08, P < 0.001) than women in the expectant group. The misoprostol group reported more adverse effects than the expectant management group (P < 0.001). Conclusion In women with an incomplete first‐trimester miscarriage who were initially treated with misoprostol, repeat administration of misoprostol was more effective than expectant management for achieving complete miscarriage at 1 week. However, misoprostol was associated with more adverse effects. Registration site and number Clinicaltrials.gov: NCT03148561.

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“…ELkholi and Hefeda worked on identifying the potential predictors of the successful medical management of first trimester miscarriage 18 in a prospective observational study and found that active vaginal bleeding and/or localized abdominal colic in the 24 hours preceding misoprostol administration, as potential predictors of the success of medical management with misoprostol. But according to the Aubert Agostini and his co-workers 19 , parity was the only predictor for the successful medical management.…”

Section: Discussionmentioning

confidence: 99%

Predicting the efficacy of vaginal misoprostol in the management of early pregnancy failures: A signal center study

Dasanayake

Ariyarathna²,

Nayake

2022

Sri Lanka J Obstet & Gynae

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Introduction:Early pregnancy loss is a situation commonly experienced by pregnant women. Management includes expectant, medical and surgical evacuation. Medical management is effective and relatively safe option and involves use of vaginal misoprostol which was recently approved to use in Sri Lanka. Proper patient selection for the medical management will improve the success rate.Objectives: Aim is to develop a predictive model using different factors to determine the efficacy of vaginal misoprostol in medical management of early pregnancy losses.Method: This was a single center retrospective descriptive study and was carried out in Teaching Hospital, Mahamodara, Galle. Eligibility criteria was medically managed early pregnancies (<12 weeks of gestation) adherent to Health Ministry guidelines. Data was retrieved using bed head tickets and was entered to data retrieval sheet. Orange Statistics 3.26, a leading free and open-source software was used for the development, testing and validation of predictive model. One hundred thirty four cases, approximately 80% of total (5% precision level), were randomly selected using randomization to train, build, score and evaluate predictive models. The remaining 20% of the cases were used once to validate each model.Results: 167 women were recruited for the analysis. Overall success rate of vaginal misoprostol was 62.3%. Majority of women (76.6%) didn't have significant adverse effects for misoprostol. Out of the twenty clinical and radiological parameters, only the presence of vaginal bleeding weakly associated with the success of medical management. Other factors were not statistically significant enough to develop a predictive model. Conclusion:Management of early pregnancy losses with misoprostol was relatively safe and successful in majority of patients. However, it was unable to develop a predictive model with selected factors in this study, except presence of per vaginal bleeding prior to treatment yield high info gain.

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Potential predictors for successful misoprostol treatment for early pregnancy failure: Clinical and color Doppler imaging study

Cited by 6 publications

References 20 publications

Misoprostol Versus Manual Vacuum Aspiration in Treatment of Missed Miscarriage in First Trimester

Misoprostol Versus Manual Vacuum Aspiration in Treatment of Missed Miscarriage in First Trimester

Retracted: Misoprostol versus expectant management in women with incomplete first‐trimester miscarriage after failed primary misoprostol treatment: A randomized clinical trial

Predicting the efficacy of vaginal misoprostol in the management of early pregnancy failures: A signal center study

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