MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study
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Publication date
2017-04-01
Authors
Lemmers, Marike
Verschoor, Marianne A C
Oude Rengerink, K
Naaktgeboren, Christiana A.
Bossuyt, Patrick M
Huirne, Judith A F
Janssen, Ineke A H
Radder, Celine
Klinkert, Ellen R
Langenveld, Josje
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Document Type
Article
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taverne
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.
Keywords
Curettage, Incomplete evacuation, Miscarriage, Misoprostol, Taverne, Obstetrics and Gynaecology, Reproductive Medicine, Journal Article, Comparative Study
Citation
Lemmers, M, Verschoor, M A C, Oude Rengerink, K, Naaktgeboren, C, Bossuyt, P M, Huirne, J A F, Janssen, I A H, Radder, C, Klinkert, E R, Langenveld, J, van der Voet, L, Siemens, F F, Bongers, M Y, van Hooff, M H, van der Ploeg, M, Sjors, F P J, Coppus, S F P J, Ankum, W M, Mol, B W J & MisoREST study group 2017, 'MisoREST : Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study', European Journal of Obstetrics, Gynecology and Reproductive Biology, vol. 211, pp. 83-89. https://doi.org/10.1016/j.ejogrb.2017.01.019