MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study

Marike Lemmers, Marianne A.C. Verschoor, Katrien Oude Rengerink, Christiana Naaktgeboren, Patrick M. Bossuyt, Judith A.F. Huirne, Ineke A.H. Janssen, Celine Radder, Ellen R. Klinkert, Josje Langenveld, Lucet van der Voet, F. Frederike Siemens, Marlies Y. Bongers, Marcel H. van Hooff, Marinus van der Ploeg, F. P.J. Sjors, S. F.P.J. Coppus, W. M. Ankum, Ben Willem J. Mol, on behalf of the MisoREST study group

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Abstract

Objective To assess the effectiveness of curettage versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. Study design We conducted a multicenter cohort study alongside a randomized clinical trial (RCT) between June 2012 until July 2014. 27 Dutch hospitals participated. Women with an incomplete evacuation after misoprostol treatment for first trimester miscarriage who declined to participate in the RCT, received treatment of their preference; curettage (n = 65) or expectant management (n = 132). A successful outcome was defined as an empty uterus on sonography at six weeks or uneventful clinical follow-up. We furthermore assessed complication rate and (re)intervention rate Results Of the 197 women who declined to participate in the RCT, 65 preferred curettage and 132 expectant management. A successful outcome was observed in 62/65 women (95%) in the surgical group versus 112/132 women (85%) in the expectant group (RR 1.1, 95% CI 1.03–1.2), with complication rates of 6.2% versus 2.3%, respectively (RR 2.7, 95% CI 0.6–12). Conclusion In women with an incomplete evacuation of the uterus after misoprostol treatment, expectant management is an effective and safe option. This finding could restrain the use of curettage in women that have used misoprostol in the treatment of first trimester miscarriage.

Original languageEnglish
Pages (from-to)83-89
Number of pages7
JournalEuropean Journal of Obstetrics & Gynecology and Reproductive Biology
Volume211
DOIs
Publication statusPublished - 1 Apr 2017
Externally publishedYes

Keywords

  • Curettage
  • Incomplete evacuation
  • Miscarriage
  • Misoprostol

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