M Lemmers1, M A C Verschoor2, K Overwater3, P M Bossuyt4, D Hendriks5, M Hemelaar6, J M Schutte7, A H Adriaanse8, W M Ankum2, J A F Huirne3, B W J Mol9. 1. Department of Obstetrics and Gynaecology, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, VU Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: marike.lemmers@gmail.com. 2. Department of Obstetrics and Gynaecology, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands. 3. Department of Obstetrics and Gynaecology, VU Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. 4. Clinical Research Unit, University of Amsterdam, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands. 5. Department of Obstetrics and Gynaecology, Amphia Ziekenhuis, P.O. Box 90158, 4800 RK, Breda, The Netherlands. 6. Department of Obstetrics and Gynaecology, Westfriesgasthuis, P.O. Box 600, 1620AR, Hoorn, The Netherlands. 7. Department of Obstetrics and Gynaecology, Isala Kliniek, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands. 8. Department of Obstetrics and Gynaecology, Noordwest Ziekenhuisgroep, P.O. Box 501, 1800 AM, Alkmaar, The Netherlands. 9. The Robinson Research Institute|School of Medicine, University of Adelaide, The South Australian Health and Medical Research Institute, Adelaide, Australia.
Abstract
OBJECTIVE: To assess fertility and obstetric outcomes in women treated with curettage or undergoing expectant management for an incomplete miscarriage after misoprostol treatment. STUDY DESIGN:Between June 2012 and July 2014, we conducted a multicentre randomised clinical trial (RCT) with a parallel cohort study for non-randomised women, treated according to their preference. In the RCT 30 women were allocated curettage and 29 expectant management. In the cohort 197 women participated; 65 underwent curettage and 132 women underwent expectant management. Primary outcome was curation, defined as either an empty uterus on sonography at six weeks or an uneventful clinical follow-up. We used questionnaires to assess fertility and obstetric outcome of the first new pregnancy subsequent to study enrolment. RESULTS: Curation was seen in 91/95 women treated with curettage (95.8%) versus 134/161 women managed expectantly (83.2%) (p=0.003). The response rate was 211/255 (82%). In 198 women pursuing anew pregnancy, conception rates were 92% (67/73) in the curettage group versus 96% (120/125) in the expectant management group (OR 0.96, 95% CI 0.89;1.03, p=0.34), with ongoing pregnancy rates of 87% (58/67) versus 78% (94/120), respectively (OR 1.12, 95% CI 0.99;1.28, p=0.226). Preterm birth rates were 1/46 in the curettage group versus 8/81 in the expectant management group (OR 0.22, 95% CI 0.03;1.71 P=0.15). Caesarean section rates were 23% and 24% for women in the curettage group and expectant management group respectively. CONCLUSION: In women with an incomplete evacuation of the uterus aftermisoprostol treatment, curettage and expectant management does not lead to different fertility and pregnancy outcomes, as compared to expectant management.
RCT Entities:
OBJECTIVE: To assess fertility and obstetric outcomes in women treated with curettage or undergoing expectant management for an incomplete miscarriage after misoprostol treatment. STUDY DESIGN: Between June 2012 and July 2014, we conducted a multicentre randomised clinical trial (RCT) with a parallel cohort study for non-randomised women, treated according to their preference. In the RCT 30 women were allocated curettage and 29 expectant management. In the cohort 197 women participated; 65 underwent curettage and 132 women underwent expectant management. Primary outcome was curation, defined as either an empty uterus on sonography at six weeks or an uneventful clinical follow-up. We used questionnaires to assess fertility and obstetric outcome of the first new pregnancy subsequent to study enrolment. RESULTS: Curation was seen in 91/95 women treated with curettage (95.8%) versus 134/161 women managed expectantly (83.2%) (p=0.003). The response rate was 211/255 (82%). In 198 women pursuing a new pregnancy, conception rates were 92% (67/73) in the curettage group versus 96% (120/125) in the expectant management group (OR 0.96, 95% CI 0.89;1.03, p=0.34), with ongoing pregnancy rates of 87% (58/67) versus 78% (94/120), respectively (OR 1.12, 95% CI 0.99;1.28, p=0.226). Preterm birth rates were 1/46 in the curettage group versus 8/81 in the expectant management group (OR 0.22, 95% CI 0.03;1.71 P=0.15). Caesarean section rates were 23% and 24% for women in the curettage group and expectant management group respectively. CONCLUSION: In women with an incomplete evacuation of the uterus after misoprostol treatment, curettage and expectant management does not lead to different fertility and pregnancy outcomes, as compared to expectant management.
Authors: Tal Margaliot Kalifa; Eyal Lang Ben Nun; Hen Y Sela; Fayez Khatib; Sorina Grisaru-Granovsky; Misgav Rottenstreich Journal: J Clin Med Date: 2022-05-13 Impact factor: 4.964
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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