OBJECTIVE: To compare immediate vs delayed medical treatment for first-trimester miscarriage. STUDY DESIGN: Randomized open-label trial in a university hospital gynecologic emergency department. Between April 2003 and April 2006, 182 women diagnosed with spontaneous abortion before 14 weeks' gestation were assigned to immediate medical treatment (oral mifepristone, followed 48 hours later by vaginal misoprostol, n = 91) or sequential management (1 week of watchful waiting followed, if necessary, by the above-described medical treatment, n = 91). Vacuum aspiration was performed in case of treatment failure, hemorrhage, pain, infection, or patient request. RESULTS: Compared with immediate medical treatment, sequential management resulted in twice as many vacuum aspirations overall (43.5% vs 19.1%; P < .001), 4 times as many emergent vacuum aspirations (20% vs 4.5%; P = .001), and twice as many unplanned visits to the emergency department (34.1% vs 16.9%; P = .009). CONCLUSION: Delaying medical treatment of first-trimester miscarriage increases the rate of unplanned surgical uterine evacuation.
RCT Entities:
OBJECTIVE: To compare immediate vs delayed medical treatment for first-trimester miscarriage. STUDY DESIGN: Randomized open-label trial in a university hospital gynecologic emergency department. Between April 2003 and April 2006, 182 women diagnosed with spontaneous abortion before 14 weeks' gestation were assigned to immediate medical treatment (oral mifepristone, followed 48 hours later by vaginal misoprostol, n = 91) or sequential management (1 week of watchful waiting followed, if necessary, by the above-described medical treatment, n = 91). Vacuum aspiration was performed in case of treatment failure, hemorrhage, pain, infection, or patient request. RESULTS: Compared with immediate medical treatment, sequential management resulted in twice as many vacuum aspirations overall (43.5% vs 19.1%; P < .001), 4 times as many emergent vacuum aspirations (20% vs 4.5%; P = .001), and twice as many unplanned visits to the emergency department (34.1% vs 16.9%; P = .009). CONCLUSION: Delaying medical treatment of first-trimester miscarriage increases the rate of unplanned surgical uterine evacuation.
Authors: Marike Lemmers; Marianne Ac Verschoor; Bobae Veronica Kim; Martha Hickey; Juan C Vazquez; Ben Willem J Mol; James P Neilson Journal: Cochrane Database Syst Rev Date: 2019-06-17
Authors: Joyce van den Berg; Charlotte C Hamel; Marcus P Snijders; Sjors F Coppus; Frank P Vandenbussche Journal: BMC Pregnancy Childbirth Date: 2019-11-27 Impact factor: 3.007
Authors: Jay Ghosh; Argyro Papadopoulou; Adam J Devall; Hannah C Jeffery; Leanne E Beeson; Vivian Do; Malcolm J Price; Aurelio Tobias; Özge Tunçalp; Antonella Lavelanet; Ahmet Metin Gülmezoglu; Arri Coomarasamy; Ioannis D Gallos Journal: Cochrane Database Syst Rev Date: 2021-06-01