Expectant Versus Medical Management of Retained Products of Conception after Induced Abortion

Abstract

<h3>Study Objective</h3> To compare the efficacy of medical management versus expectant management of retained products of conception (RPOC) after first trimester medical abortion. <h3>Design</h3> An open-label randomized controlled trial. <h3>Setting</h3> Academic tertiary-care medical center. <h3>Patients or Participants</h3> A total of 125 women who were diagnosed with RPOC 3 weeks after medical abortion by mifepristone and misoprostol. Sixty-three were allocated to expectant management and 62 to medical management. <h3>Interventions</h3> Recruited women were randomized into either expectant group or medical group (800 mcg misoprostol administered sublingually). RPOC was defined as a thick irregular endometrium (>12 mm) with positive Doppler flow. All women underwent repeat ultrasound scan every 2 weeks after randomization until a maximum of 6 weeks to rule-out persistent RPOC. Women with persistent RPOC at the end of the 6-week follow-up (9 weeks from abortion) were referred to operative hysteroscopy. The primary outcome was the rate of women referred to operative hysteroscopy. <h3>Measurements and Main Results</h3> There were no significant differences in demographic and clinical characteristics including age, BMI, nulliparity, smoking rates and mean gestational age at termination of pregnancy. The rate of women who were referred to operative hysteroscopy due to persistent RPOC was similar between the expectantly and medically managed groups (49.2% vs. 41.9%, respectively, <i>P</i> = 0.41). The mean RPOC thickness was similar between the expectant management and medical management groups (15±5.4 mm vs. 15±5.3 mm, respectively, <i>P</i> = .891). There was no difference in adverse outcomes between the two groups. <h3>Conclusion</h3> Compared with expectant management, the administration of sublingual misoprostol in women diagnosed with RPOC after first trimester medical abortion does not reduce the need for operative hysteroscopy.