Serum β-hCG concentration is a predictive factor for successful early medical abortion with vaginal misoprostol within 24 hours

Abstract

ObjectiveTo evaluate the predictive factors associated with the success of medical abortion by misoprostol monotherapy within 24 hours in the first trimester of pregnancy.MethodsThe records of 228 women with miscarriage up to 11 weeks of gestational age who underwent medical abortion by intravaginal misoprostol monotherapy were reviewed. Success of abortion was defined as complete expulsion of the conceptus without the need for surgical intervention. Outcomes of interest were success of abortion within 24 hours following administration of misoprostol.ResultsAmong 222 women who continued the process of medical abortion for 24 hours, 209 (94.1%) had a successfully completed abortion. Multivariate logistic regression showed that serum β-human chorionic gonadotropin (β-hCG) above 40,000 mIU/mL is significantly associated with failed medical abortion within 24 hours (odds ratio [OR], 7.13; 95% confidence interval [CI], 1.60–37.32; P=0.011). The area under the receiver operating characteristic curve of β-hCG level associated with successful abortion within 24 hours was 0.705 (95% CI, 0.63–0.77; P=0.007). Previous vaginal delivery seems to be significantly associated with successful abortion within 24 hours on univariate analysis (P=0.037), but the association was lost in multivariate analysis.ConclusionMisoprostol monotherapy has a high success rate for first trimester abortion. Women with serum β-hCG less than 40,000 mIU/mL are likely to achieve a successful abortion within 24 hours after intravaginal administration of misoprostol.

To operate or to wait? Doppler indices as predictors for medical termination for first trimester missed abortion

“…Prior studies by Kim et al portrayed such association, which is contrary to that of Reeves et al and Ehrnstén et al, who stated that the possibility of a successful outcome decreases as gestational age and parity advance since the stretching of uterine muscles and loss of muscle integrity lead to poor response to medical termination. This relationship was most striking in ≥ para 5 patients; this may explain the apparent contradiction with the current study as the mean parity was 4 in our patients [8][9][10]. This study shows there is a strong relationship between predicting good responder and vaginal delivery.…”

“…This inconsistency may be due to the larger sample size. Moreover, the mean age of the participants was (8.4) weeks less than the cut-off value proposed by Ehrnstén L et al [8,10]. From the PLS curve and its generated eigenvalue, the RI but not the PI stands out as significantly correlated to the success of medical termination with a cut-off value of 0.74; below which medical treatment will be successful, and above which medical treatment will most likely fail, with increased hazards of surgical intervention.…”

“…This agrees with the results of Kim et al, who declared that vaginal delivery was associated with higher and more rapid success rates. Caesarian delivery tends to alter the success of a good responder because the scarred site will be considered a weak point in disturbing uniform myometrium and its contractility, not to overlook the increased penetration by trophoblasts to the myometrium, making it difficult to expel [8,11]. Maternal age and gestational age of the dead fetus are not statistically significant; the same finding was reported in a study by Kim et al In contrast, earlier findings by Ehrnstén et al suggested that most distinct factor for surgical intervention risk was a 9-week gestational age or more at the time of treatment; the study results do not support this.…”

Predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding

“…However, it is unlikely that this had any major impact on our results. Our definition of successful treatment, also used by others [7,8,19,27,44], may also be criticized [45][46][47][48]. Absence of a gestational sac and/or cessation of vaginal bleeding may be better definitions [49].…”

“…Expectant management of miscarriages with a retained gestational sac is less likely to be successful within a few weeks, especially in women with no vaginal bleeding [13]. Most studies investigating possible predictors of treatment success of medical treatment or expectant management include both incomplete miscarriages and embryonic or anembryonic miscarriages and/or both patients with and without vaginal bleeding [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. This makes results difficult to generalize.…”