Melissa Lavecchia1, Haim A Abenhaim2. 1. Department of Obstetrics and Gynaecology, Jewish General Hospital, McGill University, Montreal QC. 2. Department of Obstetrics and Gynaecology, Jewish General Hospital, McGill University, Montreal QC; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montreal QC.
Abstract
OBJECTIVE: Women with failure of an early pregnancy and a gestational age of <8 weeks are considered good candidates for medical management. The purpose of our study was to evaluate the effect of menstrual age on the outcome of medical management in women with loss of a pregnancy at an estimated gestational age<8 weeks by ultrasound (US). METHODS: We conducted a retrospective cohort study of all women discharged from the emergency department (ED) between 2011 and 2013 with a diagnosis of early pregnancy failure who were managed with misoprostol and who had a gestational age of <8 weeks on US. We used logistic regression to estimate the effect of menstrual age on failed medical management, defined as requiring dilatation and curettage (D and C) or having an unplanned return to the ED (URED). RESULTS: Among 823 pregnant women presenting to the ED with first trimester bleeding, 199 had pregnancy failure at <8 weeks by US and were discharged to use misoprostol. Increasing menstrual age was associated with an increased risk of D and C and URED. Specifically, the risk of D and C was 11.8% at <8 weeks, 18.5% at 8 to 9 weeks, 25.3% at 10 to 11 weeks, and 30.6% at ≥12 weeks (P<0.05). The risk of URED was 14.7% at <8 weeks, 27.8% at 8 to 9 weeks, 36.0% at 10 to 11 weeks, and 41.7% at ≥12 weeks (P<0.05). CONCLUSION: Increasing gestational age according to menstrual dates is associated with an increased rate of failed medical management in women with early pregnancy loss, independent of gestational age estimated by ultrasound. Gestational age by menstrual dates should be considered when discussing treatment options with women who have an early pregnancy failure.
OBJECTIVE:Women with failure of an early pregnancy and a gestational age of <8 weeks are considered good candidates for medical management. The purpose of our study was to evaluate the effect of menstrual age on the outcome of medical management in women with loss of a pregnancy at an estimated gestational age<8 weeks by ultrasound (US). METHODS: We conducted a retrospective cohort study of all women discharged from the emergency department (ED) between 2011 and 2013 with a diagnosis of early pregnancy failure who were managed with misoprostol and who had a gestational age of <8 weeks on US. We used logistic regression to estimate the effect of menstrual age on failed medical management, defined as requiring dilatation and curettage (D and C) or having an unplanned return to the ED (URED). RESULTS: Among 823 pregnant women presenting to the ED with first trimester bleeding, 199 had pregnancy failure at <8 weeks by US and were discharged to use misoprostol. Increasing menstrual age was associated with an increased risk of D and C and URED. Specifically, the risk of D and C was 11.8% at <8 weeks, 18.5% at 8 to 9 weeks, 25.3% at 10 to 11 weeks, and 30.6% at ≥12 weeks (P<0.05). The risk of URED was 14.7% at <8 weeks, 27.8% at 8 to 9 weeks, 36.0% at 10 to 11 weeks, and 41.7% at ≥12 weeks (P<0.05). CONCLUSION: Increasing gestational age according to menstrual dates is associated with an increased rate of failed medical management in women with early pregnancy loss, independent of gestational age estimated by ultrasound. Gestational age by menstrual dates should be considered when discussing treatment options with women who have an early pregnancy failure.