Predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding

Anna Fernlund,Lil Valentin,Ligita Jokubkiene,Povilas Sladkevicius

doi:10.1007/s00404-020-05672-6

Anna Fernlund, Lil Valentin + Show 2 more

Open Access

https://doi.org/10.1007/s00404-020-05672-6

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Abstract

PurposeTo identify predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding.MethodsThis was a planned secondary analysis of data from a published randomized controlled trial comparing expectant management with vaginal single dose of 800 µg misoprostol treatment of women with embryonic or anembryonic miscarriage. Predefined variables—serum-progesterone, serum-β-human chorionic gonadotropin, parity, previous vaginal deliveries, gestational age, clinical symptoms (bleeding and pain), mean diameter and shape of the gestational sac, crown-rump-length, type of miscarriage, and presence of blood flow in the intervillous space—were tested as predictors of treatment success (no gestational sac in the uterine cavity and maximum anterior–posterior intracavitary diameter was ≤ 15 mm as measured with transvaginal ultrasound on a sagittal view) in univariable and multivariable logistic regression.ResultsVariables from 174 women (83 expectant management versus 91 misoprostol) were analyzed for prediction of complete miscarriage at ≤ 17 days. In patients managed expectantly, the rate of complete miscarriage was 62.7% (32/51) in embryonic miscarriages versus 37.5% (12/32) in anembryonic miscarriages (P = 0.02). In multivariable logistic regression, the likelihood of success increased with increasing gestational age, increasing crown-rump-length and decreasing gestational sac diameter. Misoprostol treatment was successful in 80.0% (73/91). No variable predicted success of misoprostol treatment.ConclusionsComplete miscarriage after expectant management is significantly more likely in embryonic miscarriage than in anembryonic miscarriage. Gestational age, crown-rump-length, and gestational sac diameter are independent predictors of success of expectant management. Predictors of treatment success may help counselling women with early miscarriage.

Highlights

Miscarriage occurs in 10–15% of clinically recognized pregnancies [1,2,3]
Clinical variables Gestational age according to last menstrual period Mean Median Vaginal delivery Yes No Parity Parous Nulliparous Bleeding at inclusiond Moderate/heavy None/mild Pain at inclusion Yes No
Ninety-five women were allocated to expectant management and 94 to misoprostol treatment

Summary

Introduction

Miscarriage occurs in 10–15% of clinically recognized pregnancies [1,2,3]. Expectant or medical management are alternatives to surgical evacuation [4,5,6]. Most studies investigating possible predictors of treatment success of medical treatment or expectant management include both incomplete miscarriages and embryonic or anembryonic miscarriages and/or both patients with and without vaginal bleeding [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32]. The aim of this work is to identify predictors of success of expectant management or misoprostol treatment in a welldefined group of patients, i.e., patients with embryonic or anembryonic miscarriage reporting vaginal bleeding

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