Pregnancy loss: French clinical practice guidelines

Huchon, Cyrille; Deffieux, X.; Beucher, G.; Capmas, P.; Carcopino, Xavier; Costédoat-Chalumeau, Nathalie; Delabaere, Amélie; Gallot, V.; Iraola, E.; Lavoué, Vincent; Legendre, Guillaume; Lejeune-Saada, V.; Lévèque, J; Nedellec, S.; Nizard, J.; Quibel, Thibaud; Subtil, D.; Vialard, François; Lémery, D.

doi:10.1016/j.ejogrb.2016.02.015

Cited by 64 publications

(72 citation statements)

References 18 publications

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“…Vaginal misoprostol of 800 ug was recommend for missed abortion by National Institute for Health and Care Excellence(NICE) and some clinical guidelines 8, 20 . The results of our meta-analysis lead support to this regimen for medical treatment of missed abortion, however the question of whether sublingual misoprostol of 600 ug is better raises.…”

Section: Discussionmentioning

confidence: 99%

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Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

Marwah

Wang

et al. 2017

Sci Rep

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The efficacy and safety of misoprostol alone for missed abortion varied with different regimens. To evaluate existing evidence for the medical management of missed abortion using misoprostol, we undertook a comprehensive review and meta-analysis. The electronic literature search was conducted using PubMed, the Cochrane Library, Embase, EBSCOhost Online Research Databases, Springer Link, ScienceDirect, Web of Science, Ovid Medline and Google Scholar. 18 studies of 1802 participants were included in our analysis. Compared with vaginal misoprostol of 800 ug or sublingual misoprostol of 600 ug, lower-dose regimens (200 ug or 400 ug) by any route of administration tend to be significantly less effective in producing abortion within about 24 hours. In terms of efficacy, the most effective treatment was sublingual misoprostol of 600 ug and the least effective was oral misoprostol of 400 ug. In terms of tolerability, vaginal misoprostol of 400 ug was reported with fewer side effects and sublingual misoprostol of 600 ug was reported with more side effects. Misoprostol is a non-invasive, effective medical method for completion of abortion in missed abortion. Sublingual misoprostol of 600 ug or vaginal misoprostol of 800 ug may be a good choice for the first dose. The ideal dose and medication interval of misoprostol however needs to be further researched.Missed abortion is defined as unrecognized intrauterine death of the embryo or fetus without expulsion of the products of conception. It constitutes approximately 15% of clinically diagnosed pregnancies 1 . Women experiencing a missed abortion may have no self-awareness due to the lack of obvious symptoms.With around 95% success rate, surgical evacuation is regarded as the standard treatment for missed abortion, which had been widely performed all over the world in the past 50 years 2 . However, the costs of surgery and hospitalization, as well as the complications associated with surgery and anaesthesia are a major unresolved concern. Besides infection and bleeding, decreased fertility caused by intrauterine adhesions may be unacceptable for women with missed abortion, who have not yet fulfilled their motherhood desires. Some studies have thus suggested that expectant or medical management might be more suitable instead of surgical evacuation 3,4 .Expectant management has been reported with unpredictable success rate ranging from 25-76% 5-7 . Waiting for spontaneous expulsion of the products of conception would waste much time, during which women may suffer uncertainty and anxiety 5 . When additional surgical evacuation is needed owing to failure, they may suffer from an emotional breakdown. It is thus not recommended for missed early miscarriage due to the risks of emergency surgical treatment and blood transfusion 8 .Misoprostol is a synthetic prostaglandin E1 analogue which was originally developed to prevent non-steroidal anti-inflammatory drugs related gastric ulcers. However it has been used for various other indications in obstetrics and gynaecology. Medical manag...

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Section: Discussionmentioning

confidence: 99%

“…When additional surgical evacuation is needed owing to failure, they may suffer from an emotional breakdown. It is thus not recommended for missed early miscarriage due to the risks of emergency surgical treatment and blood transfusion 8 .…”

Section: Introductionmentioning

confidence: 99%

Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

Marwah

Wang

et al. 2017

Sci Rep

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“…Aspirin ve düşük moleküler ağırlıklı heparin kombine tedavisi sadece geç gebelik kaybı ve antifosfolipid sendromu (edinsel trombofili) birlikteliği olan vakalarda önerilmelidir. Bu kombinasyon tromboembolik hadisesi olmayan tekrarlayan gebelik kaybı ve genetik trombofilili hastalara profilaksi amaçlı önerilmemelidir 21 .…”

Section: Koagülasyon Sistemi Bozukluklarıunclassified

“…Bu durum TGK'lı olguların %23'ü ile 60'ı arasında değişen oranlarda bildirilmektedir 47 . Serum progesteron seviyesi midluteal fazda 12 ng/ml altında olduğunda gebeliğin kaybedilme riski artar 21 .…”

Section: Hormonal Nedenlerunclassified

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Approach to Recurrent Early Pregnancy Loss

Deniz¹,

Baykuş²,

Kavak³

2016

Kafkas J Med Sci

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Abortus is the most common complication of pregnancy. Recurrent pregnancy lost is the termination of the sequential termination of GirişErken gebelik kayıpları kadın hayatının en uzun döne-mi olan reprodüktif döneminin sık karşılaşılan problemlerinden biridir. Abortus gebeliğin en sık görülen komplikasyonu olup suprapubik ağrı ve uterin kramplarla ortaya çıkan vajinal kanama ile beraber gebeliğin uterustan atılması, gebeliğe dair bulgu ve semptomların kaybolması olarak tariflenir 1 . Dünya sağlık örgütü ise gebelik ürününün ağırlığı ve gebelik süreci kriter alınarak, 20. gebelik haftasından önce, 500 gramın altındaki embriyo veya fetüs ve eklerinin tamamının ya da bir kısmının uterustan atılması durumunu abortus olarak tariflenmiştir 2 . On ikinci gebelik haftasına kadar olan abortuslar erken abortus, 12.-20. gebelik haftaları arasında olan abortuslar ise geç abortus olarak adlandırılmaktadır.Geniş bir yelpazeye sahip olan spontan abortus insidansı %15-40 civarındadır. Spontan abortusların %62 si 12. gebelik haftasından önce görülmektedir.

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Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion

Huchon

Drioueche

Koskas

et al. 2023

JAMA

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ImportanceVacuum aspiration is commonly used to remove retained products of conception in patients with incomplete spontaneous abortion. Scarring of the uterine cavity may occur, potentially impairing future fertility. A procedural alternative, operative hysteroscopy, has gained popularity with a presumption of better future fertility.ObjectiveTo assess the superiority of hysteroscopy to vacuum aspiration for subsequent pregnancy in patients with incomplete spontaneous abortion who intend to have future pregnancy.Design, Setting, and ParticipantsThe HY-PER randomized, controlled, single-blind trial included 574 patients between November 6, 2014, and May 3, 2017, with a 2-year duration of follow-up. This multicenter trial recruited patients in 15 French hospitals. Individuals aged 18 to 44 years and planned for surgery for an incomplete spontaneous abortion with plans to subsequently conceive were randomized in a 1:1 ratio.InterventionsSurgical treatment by hysteroscopy (n = 288) or vacuum aspiration (n = 286).Main Outcomes and MeasuresThe primary outcome was a pregnancy of at least 22 weeks’ duration during 2-year follow-up.ResultsThe intention-to-treat analyses included 563 women (mean [SD] age, 32.6 [5.4] years). All aspiration procedures were completed. The hysteroscopic procedure could not be completed for 19 patients (7%), 18 of which were converted to vacuum aspiration (8 with inability to completely resect, 7 with insufficient visualization, 2 with anesthetic complications that required a shortened procedure, 1 with equipment failure). One hysteroscopy failed due to a false passage during cervical dilatation. During the 2-year follow-up, 177 patients (62.8%) in the hysteroscopy group and 190 (67.6%) in the vacuum aspiration (control) group achieved the primary outcome (difference, −4.8% [95% CI, −13% to 3.0%]; P = .23). The time-to-event analyses showed no statistically significant difference between groups for the primary outcome (hazard ratio, 0.87 [95% CI, 0.71 to 1.07]). Duration of surgery and hospitalization were significantly longer for hysteroscopy. Rates of new miscarriages, ectopic pregnancies, Clavien-Dindo surgical complications of grade 3 or above (requiring surgical, endoscopic, or radiological intervention or life-threatening event or death), and reinterventions to remove remaining products of conception did not differ between groups.Conclusions and RelevanceSurgical management by hysteroscopy of incomplete spontaneous abortions in patients intending to conceive again was not associated with more subsequent births or a better safety profile than vacuum aspiration. Moreover, operative hysteroscopy was not feasible in all cases.Trial RegistrationClinicalTrials.gov Identifier: NCT02201732

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Pregnancy loss: French clinical practice guidelines

Cited by 64 publications

References 18 publications

Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

Approach to Recurrent Early Pregnancy Loss

Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion

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