O-41: Medical treatment with misoprostol for early failure of pregnancies conceived following ART: A promising treatment option

Abstract

To compare the success rate of medical treatment with misoprostol for early pregnancy failure among pregnancies achieved following ART versus spontaneous pregnancies. Prospective study. Prospective recruitment of all women who underwent medical treatment for early pregnancy failure with a CRL up to 25 mm in our medical center between 9/2001 and 8/2005. The treatment protocol included vaginal placement fo 800mcg misoprostol. A second dose of misoprostol was given 1-3 days later if the sonographic evaluation showed an endometrial thickness ≥15mm and sonography was performed again after the next menstrual bleeding. Those with a persistent gestational sac underwent curettage. When residual tissue was suspected, diagnostic followed if required by operative hysteroscopy were performed. 201 women were enrolled. Of them, 48 had a pregnancy followed ovulation induction or IVF (group A) and 153 women had a spontaneous pregnancy (Group B). Success rates, defined as no need for surgical intervention were achieved in 91.7% (44/48) of the patients from group A and in 73.2% (112/153) of group B, (p=0.009). Stepwise unconditional logistic regression analysis was performed. The following variables were considered: manner of conception (spontaneous vs. ART), gestational age of the fetal demise, gestational age at the diagnosis and the time interval between those dates. According to the logistic regression results, success rate was influenced only by the manner of conception. The chance of success with medical abortion was increased by 3.7 folds for ART pregnancies compared with spontaneous pregnancies achieved following (OR 3.7, 95% CI 1.22-11.1, P < .009). Medical treatment of missed abortion seems to be a valuable treatment option for spontaneous abortions in pregnancies achieved by ovulation induction.