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DOI: 10.1055/s-0028-1087106
Medical Management of Early Pregnancy Failure: How to Treat and What to Expect
Publikationsverlauf
Publikationsdatum:
29. September 2008 (online)
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ABSTRACT
Medical management is gaining acceptance as a treatment option for women with early pregnancy failure (EPF). We reviewed randomized trials comparing misoprostol for EPF with surgical (dilation and curettage) or expectant management. Overall, ~85% of women with EPF can expect complete uterine evacuation after one or two doses of 600 or 800 μg misoprostol without surgery. Medical management is safe. As with surgical therapy, serious complications are rare. Women undergoing medical management of EPF may expect moderate pain and bleeding for several days, which may persist for 2 weeks or longer. Side effects associated with misoprostol are common; however, acceptability of medical management remains high.
KEYWORDS
Early pregnancy failure - miscarriage - spontaneous abortion - incomplete abortion - misoprostol
REFERENCES
-
1 Alberman E.
Spontaneous abortions: epidemiology . In: Stabile GG TH Spontaneous Abortion: Diagnosis and Treatment. London, United Kingdom; Springer-Verlag 1992: 19-20 - 2 Warburton D, Fraser F C. Spontaneous abortion risks in man: data from reproductive histories collected in a medical genetics unit. Am J Hum Genet. 1964; 16 1-25
- 3 Chen B A, Creinin M D. Contemporary management of early pregnancy failure. Clin Obstet Gynecol. 2007; 50 67-88
- 4 Graziosi G C, Mol B W, Ankum W M et al.. Management of early pregnancy loss. Int J Gynaecol Obstet. 2004; 86 337-346
- 5 Sotiriadis A, Makrydimas G, Papatheodorou S et al.. Expectant, medical, or surgical management of first-trimester miscarriage: a meta-analysis. Obstet Gynecol. 2005; 105(5 Pt 1) 1104-1113
- 6 Ayudhaya O P, Herabutya Y, Chanrachakul B et al.. A comparison of the efficacy of sublingual and oral misoprostol 400 microgram in the management of early pregnancy failure: a randomized controlled trial. J Med Assoc Thai. 2006; 89(Suppl 4) S5-S10
- 7 Bagratee J S, Khullar V, Regan L et al.. A randomized controlled trial comparing medical and expectant management of first trimester miscarriage. Hum Reprod. 2004; 19 266-271
- 8 Demetroulis C, Saridogan E, Kunde D et al.. A prospective randomized control trial comparing medical and surgical treatment for early pregnancy failure. Hum Reprod. 2001; 16 365-369
- 9 Graziosi G C, Mol B W, Reuwer P J et al.. Misoprostol versus curettage in women with early pregnancy failure after initial expectant management: a randomized trial. , [see comment] Hum Reprod. 2004; 19 1894-1899
- 10 Gronlund A, Gronlund L, Clevin L et al.. Management of missed abortion: comparison of medical treatment with either mifepristone + misoprostol or misoprostol alone with surgical evacuation. A multi-center trial in Copenhagen county, Denmark. Acta Obstet Gynecol Scand. 2002; 81 1060-1065
- 11 Kovavisarach E, Jamnansiri C. Intravaginal misoprostol 600 microg and 800 microg for the treatment of early pregnancy failure. Int J Gynaecol Obstet. 2005; 90 208-212
- 12 Ngai S W, Chan Y M, Tang O S et al.. Vaginal misoprostol as medical treatment for first trimester spontaneous miscarriage. Hum Reprod. 2001; 16 1493-1496
- 13 Niinimaki M, Jouppila P, Martikainen H et al.. A randomized study comparing efficacy and patient satisfaction in medical or surgical treatment of miscarriage. Fertil Steril. 2006; 86 367-372
- 14 Stockheim D, Machtinger R, Wiser A et al.. A randomized prospective study of misoprostol or mifepristone followed by misoprostol when needed for the treatment of women with early pregnancy failure. Fertil Steril. 2006; 86 956-960
- 15 Tang O S, Ong C Y, Tse K Y et al.. A randomized trial to compare the use of sublingual misoprostol with or without an additional 1 week course for the management of first trimester silent miscarriage. Hum Reprod. 2006; 21 189-192
- 16 Trinder J, Brocklehurst P, Porter R et al.. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). , [see comment] BMJ. 2006; 332 1235-1240
- 17 Zhang J, Gilles J M, Barnhart K et al.. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. , [see comment] N Engl J Med. 2005; 353 761-769
- 18 Blohm F, Friden B E, Milsom I et al.. A randomised double blind trial comparing misoprostol or placebo in the management of early miscarriage. BJOG. 2005; 112 1090-1095
- 19 Nielsen S, Hahlin M, Platz-Christensen J. Randomised trial comparing expectant with medical management for first trimester miscarriages. , [see comment] Br J Obstet Gynaecol. 1999; 106 804-807
- 20 Chung T K, Lee D T, Cheung L P et al.. Spontaneous abortion: a randomized, controlled trial comparing surgical evacuation with conservative management using misoprostol. , [see comment] Fertil Steril. 1999; 71 1054-1059
- 21 Graziosi G C, van der Steeg J W, Reuwer P H et al.. Economic evaluation of misoprostol in the treatment of early pregnancy failure compared to curettage after an expectant management. Hum Reprod. 2005; 20 1067-1071
- 22 Tang O S, Schweer H, Seyberth H W et al.. Pharmacokinetics of different routes of administration of misoprostol. , [see comment] Hum Reprod. 2002; 17 332-336
- 23 Zieman M, Fong S K, Benowitz N L et al.. Absorption kinetics of misoprostol with oral or vaginal administration. Obstet Gynecol. 1997; 90 88-92
- 24 Ngoc N T, Blum J, Westheimer E et al.. Medical treatment of missed abortion using misoprostol. Int J Gynaecol Obstet. 2004; 87 138-142
- 25 Pang M W, Lee T S, Chung T K. Incomplete miscarriage: a randomized controlled trial comparing oral with vaginal misoprostol for medical evacuation. Hum Reprod. 2001; 16 2283-2287
- 26 Tang O S, Lau W N, Ng E H et al.. A prospective randomized study to compare the use of repeated doses of vaginal with sublingual misoprostol in the management of first trimester silent miscarriages. Hum Reprod. 2003; 18 176-181
- 27 Gilles J M, Creinin M D, Barnhart K et al.. A randomized trial of saline solution-moistened misoprostol versus dry misoprostol for first-trimester pregnancy failure. Am J Obstet Gynecol. 2004; 190 389-394
- 28 Blanchard K, Taneepanichskul S, Kiriwat O et al.. Two regimens of misoprostol for treatment of incomplete abortion. Obstet Gynecol. 2004; 103(5 Pt 1) 860-865
- 29 Ngoc N T, Blum J, Durocher J et al.. A randomized controlled study comparing 600 versus 1,200 microg oral misoprostol for medical management of incomplete abortion. Contraception. 2005; 72 438-442
- 30 Phupong V, Taneepanichskul S, Kriengsinyot R et al.. Comparative study between single dose 600 microg and repeated dose of oral misoprostol for treatment of incomplete abortion. , [see comment] Contraception. 2004; 70 307-311
- 31 Davis A R, Hendlish S K, Westhoff C et al.. Bleeding patterns after misoprostol vs surgical treatment of early pregnancy failure: results from a randomized trial. Am J Obstet Gynecol. 2007; 196 e31-e37
- 32 Davis A R, Robilotto C M, Westhoff C L et al.. Bleeding patterns after vaginal misoprostol for treatment of early pregnancy failure. Hum Reprod. 2004; 19 1655-1658
Angela DempseyM.D.
Department of Obstetrics and Gynecology, Medical University of South Carolina
135 Cannon SF., 2nd fl., Charleston, SC 29425
eMail: ard2117@columbia.edu