Single versus repeat doses of misoprostol for treatment of early pregnancy loss—a randomized clinical trial

Mizrachi, Yossi; Dekalo, Ann; Gluck, Ohad; Miremberg, Hadas; Dafna, Lotem; Feldstein, Ohad; Weiner, Eran; Bar, Jacob; Sagiv, Ron

doi:10.1093/humrep/dex074

Cited by 16 publications

(15 citation statements)

References 17 publications

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“…The overall success rate of medical treatment in our study was 75%, which is similar to rates reported in the literature (3,4,9,10).…”

Section: Discussionsupporting

confidence: 90%

“…As opposed to surgical management, namely dilation & curettage (D&C), the advantages of medical treatment in cases of EPL are well known. Nevertheless, up to 30% of patients treated medically will ultimately require an additional surgical procedure (3,4,6). When counselling patients with EPL regarding the optimal treatment, we prefer to tailor therapy based on the individual patient's characteristics and predictors of success.…”

Section: Introductionmentioning

confidence: 99%

“…Medical treatment with misoprostol is a well-known and safe method, with success rates of 70-90% (1,(3)(4)(5). As opposed to surgical management, namely dilation & curettage (D&C), the advantages of medical treatment in cases of EPL are well known.…”

Section: Introductionmentioning

confidence: 99%

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Medical Treatment for Earl Pregnancy Loss Following In Vitro Fertilization Compared to Spontaneous Pregnancies: a Retrospective Study

Gluck

Barber

Feldstein

et al. 2022

Preprint

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Background: Misoprostol is a well-studied medical treatment for early pregnancy loss (EPL), with success rates ranging between 70-90%. However, treatment failure is associated with major patient discomfort, including the need for surgical intervention to evacuate the uterus. It was reported that medical treatment was especially successful among women who conceived after in vitro fertilization (IVF). We aimed to study if there is a difference in rates of medical treatment failures for EPL between pregnancies conceived by IVF and spontaneous pregnancies. This is a retrospective cohort study. Methods: All women who underwent medical treatment for EPL at our institute between 07/2015 and 12/2020 were included. The cohort was divided into two groups: IVF and spontaneous pregnancies.Treatment failure was defined as any surgical intervention, namely, dilation & curettage (D&C) and/or hysteroscopy, due to retained products of gestation. Baseline characteristics and failure rates were compared between the groups.Results: Overall, 775 patients were included, of which 195 (25.1%) ultimately required surgical intervention. There was no difference between the groups in the rate of treatment failure. However, among the IVF group, the rate of emergency D&C was lower (3.6% vs. 9.8%, p=0.001) compared to the spontaneous group. Conclusion: In cases of medical treatment for EPL, IVF pregnancies have lower chances to undergo emergency D&C, compared to spontaneous pregnancies. Overall, there are no differences in rates of treatment failure between IVF and spontaneous pregnancies.

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“…The overall success rate of medical treatment in our study was 75%, which is similar to rates reported in the literature (3,4,9,10).…”

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Medical Treatment for Earl Pregnancy Loss Following In Vitro Fertilization Compared to Spontaneous Pregnancies: a Retrospective Study

Gluck

Barber

Feldstein

et al. 2022

Preprint

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“…The same is reported to be 16% in another study. 16 Overall the results of this study are almost parallel to the research work reported in other similar studies.…”

Section: Discussionsupporting

confidence: 90%

“…The same dosage schedule is used in another study and they showed an overall success rate of 77%. 16 The largest randomized controlled trial conducted in the United States of America (USA) demonstrated 71% expulsion with first dose of Misoprostol by day 3 and increased to 84% with the 2 nd dose (800 microgram). For surgical evacuation, a success rate of 93% was reported.…”

Section: Discussionmentioning

confidence: 99%

Management of Early Pregnency Loss by Surgical Evacuation or Medical Termination Which is a Better Choice?

Hayat¹,

Afzal²,

Bilal³

et al. 2020

BIOMEDICA

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Background and Objective: Comparative efficacy of medical termination has always remained debatable as compared to surgical techniques. The study was designed to assess the safety, acceptability and success of oral Misoprostol as an agent of medical termination as compared to surgical evacuation in cases of early pregnancy loss.Methods: This was a quasi-experimental study conducted in Department of Obstetrics and Gynaecology at Sughra Shafi Medical Complex, affiliated with Sahara Medical College Narowal from August 2017 to February 2019. Diagnosed cases of missed miscarriage before 13 weeks (n = 150) were allocated either for surgical evacuation (n = 50) or medical termination by oral Misoprostol (n = 100) on patients' own choice after counselling. Effective dosage schedule of Misoprostol, its adverse effects, number of days taken for complete expulsion and duration of hospital stay were recorded. Main outcome measure was successful termination.Results: Patients enrolled for surgical evacuation had 100% success rate while those in medical termination had 80% success rate and 20% treatment failure.Significant differences were also observed in symptoms, bleeding and hospital stays between the two groups. Conclusion:Surgical evacuation is still a gold standard method recommended for suitable cases, while medical termination by Misoprostolis low cost, better accepted and effective but has unpredictable outcomes.

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Medical treatment for early fetal death (less than 24 weeks)

Lemmers

Verschoor

Kim

et al. 2019

Cochrane Database of Systematic Reviews

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Single versus repeat doses of misoprostol for treatment of early pregnancy loss—a randomized clinical trial

Abstract: 19 August 2015.

Cited by 16 publications

References 17 publications

Medical Treatment for Earl Pregnancy Loss Following In Vitro Fertilization Compared to Spontaneous Pregnancies: a Retrospective Study

Medical Treatment for Earl Pregnancy Loss Following In Vitro Fertilization Compared to Spontaneous Pregnancies: a Retrospective Study

Management of Early Pregnency Loss by Surgical Evacuation or Medical Termination Which is a Better Choice?

Medical treatment for early fetal death (less than 24 weeks)

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