Effect of Menstrual Age on Medical Management Failure in Women With Early Pregnancy Loss [295

Abstract

INTRODUCTION: Women with gestational age less than 8 weeks are considered good candidates for medical management of early pregnancy failure. The purpose of our study was to evaluate the effect of menstrual age on failed medical management among women with early pregnancy failure estimated at less than 8 weeks of gestation by ultrasonography. METHODS: We conducted a retrospective cohort study on all women discharged from the emergency department with a diagnosis of early pregnancy failure who were managed with misoprostol and had a gestational age less than 8 weeks on ultrasonography between 2011 and 2013. We used logistic regression to estimate the effect of menstrual age on failed medical management defined as dilatation and curettage (D&C) or unplanned return to the emergency department. RESULTS: Among 823 women presenting to the emergency department with first-trimester bleeding, 199 had failed pregnancy less than 8 weeks of gestation by ultrasonography and were discharged with misoprostol. Menstrual age was associated with an increased risk of D&C and unplanned return to the emergency department. Specifically, risk of D&C was 11.8% at less than 8 weeks of gestation, 18.5% at 8–9 weeks of gestation, 25.3% at 10–11 weeks of gestation, and 30.6% at 12 weeks of gestation or greater (P=.04). As well, risk of unplanned return to the emergency department was 14.7% at less than 8 weeks of gestation, 27.8% at 8–9 weeks of gestation, 36.0% at 10–11 weeks of gestation, and 41.7% at 12 weeks of gestation or greater (P=.01). CONCLUSION: Menstrual gestational age is an important predictor of failed medical management of early pregnancy loss that is independent of ultrasound-estimated gestational age. Menstrual gestational age should be considered when discussing treatment options with women who have an early pregnancy failure.