Predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding
PURPOSE: To identify predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding.
METHODS: This was a planned secondary analysis of data from a published randomized controlled trial comparing expectant management with vaginal single dose of 800 µg misoprostol treatment of women with embryonic or anembryonic miscarriage. Predefined variables-serum-progesterone, serum-β-human chorionic gonadotropin, parity, previous vaginal deliveries, gestational age, clinical symptoms (bleeding and pain), mean diameter and shape of the gestational sac, crown-rump-length, type of miscarriage, and presence of blood flow in the intervillous space-were tested as predictors of treatment success (no gestational sac in the uterine cavity and maximum anterior-posterior intracavitary diameter was ≤ 15 mm as measured with transvaginal ultrasound on a sagittal view) in univariable and multivariable logistic regression.
RESULTS: Variables from 174 women (83 expectant management versus 91 misoprostol) were analyzed for prediction of complete miscarriage at ≤ 17 days. In patients managed expectantly, the rate of complete miscarriage was 62.7% (32/51) in embryonic miscarriages versus 37.5% (12/32) in anembryonic miscarriages (P = 0.02). In multivariable logistic regression, the likelihood of success increased with increasing gestational age, increasing crown-rump-length and decreasing gestational sac diameter. Misoprostol treatment was successful in 80.0% (73/91). No variable predicted success of misoprostol treatment.
CONCLUSIONS: Complete miscarriage after expectant management is significantly more likely in embryonic miscarriage than in anembryonic miscarriage. Gestational age, crown-rump-length, and gestational sac diameter are independent predictors of success of expectant management. Predictors of treatment success may help counselling women with early miscarriage.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:302 |
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| Enthalten in: |
Archives of gynecology and obstetrics - 302(2020), 5 vom: 07. Nov., Seite 1279-1296 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Fernlund, Anna [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 15.12.2020 Date Revised 23.03.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00404-020-05672-6 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM312154593 |
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| 100 | 1 | |a Fernlund, Anna |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 15.12.2020 | ||
| 500 | |a Date Revised 23.03.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a PURPOSE: To identify predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding | ||
| 520 | |a METHODS: This was a planned secondary analysis of data from a published randomized controlled trial comparing expectant management with vaginal single dose of 800 µg misoprostol treatment of women with embryonic or anembryonic miscarriage. Predefined variables-serum-progesterone, serum-β-human chorionic gonadotropin, parity, previous vaginal deliveries, gestational age, clinical symptoms (bleeding and pain), mean diameter and shape of the gestational sac, crown-rump-length, type of miscarriage, and presence of blood flow in the intervillous space-were tested as predictors of treatment success (no gestational sac in the uterine cavity and maximum anterior-posterior intracavitary diameter was ≤ 15 mm as measured with transvaginal ultrasound on a sagittal view) in univariable and multivariable logistic regression | ||
| 520 | |a RESULTS: Variables from 174 women (83 expectant management versus 91 misoprostol) were analyzed for prediction of complete miscarriage at ≤ 17 days. In patients managed expectantly, the rate of complete miscarriage was 62.7% (32/51) in embryonic miscarriages versus 37.5% (12/32) in anembryonic miscarriages (P = 0.02). In multivariable logistic regression, the likelihood of success increased with increasing gestational age, increasing crown-rump-length and decreasing gestational sac diameter. Misoprostol treatment was successful in 80.0% (73/91). No variable predicted success of misoprostol treatment | ||
| 520 | |a CONCLUSIONS: Complete miscarriage after expectant management is significantly more likely in embryonic miscarriage than in anembryonic miscarriage. Gestational age, crown-rump-length, and gestational sac diameter are independent predictors of success of expectant management. Predictors of treatment success may help counselling women with early miscarriage | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a First-trimester pregnancy | |
| 650 | 4 | |a Logistic models prediction | |
| 650 | 4 | |a Miscarriage | |
| 650 | 4 | |a Misoprostol | |
| 650 | 4 | |a Pregnancy complications | |
| 650 | 7 | |a Abortifacient Agents, Nonsteroidal |2 NLM | |
| 650 | 7 | |a Chorionic Gonadotropin, beta Subunit, Human |2 NLM | |
| 650 | 7 | |a Oxytocics |2 NLM | |
| 650 | 7 | |a Misoprostol |2 NLM | |
| 650 | 7 | |a 0E43V0BB57 |2 NLM | |
| 700 | 1 | |a Jokubkiene, Ligita |e verfasserin |4 aut | |
| 700 | 1 | |a Sladkevicius, Povilas |e verfasserin |4 aut | |
| 700 | 1 | |a Valentin, Lil |e verfasserin |4 aut | |
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