Predictors of Efficacy of Medical Management of First Trimester Miscarriage: A Prospective Cohort Study in an Early Pregnancy Unit

Abstract

Spontaneous miscarriage is the commonest complication of the first trimester of pregnancy. Non-surgical management is both a safe and an acceptable alternative. However, there is a paucity of evidence on factors that influence the success rate and efficacy of medical management of first trimester miscarriage. This is a prospective cohort study looking at the potential factors that influence the efficacy of medical management of first trimester miscarriage, including clinical factors, ultrasound features and biochemical markers. Cases were recruited from the early pregnancy unit at the Coombe Women and Infants University Hospital (CWIUH) over a period of 18 months [October-2015 to April-2017]. Cases that underwent medical management were analyzed for primary and secondary outcomes. Statistical analysis was used to assess factors influencing the efficacy of medical management. In total, 186 cases were analyzed. Mean maternal age was 33.5 years and 35.4% were primigravidas. Mean BMI at presentation was 26kg/m2 . In this study, body mass index was a significant predictor (p= 0.005) of efficacy of medical management. The crown-rump length was also a significant predictor (p = 0.005) of efficacy of treatment, particularly when combined with HCG levels. Decision tree analysis showed an 81.3% likelihood of non-surgical outcome with serum bHCG levels <26,528. Medical management of miscarriage offers an alternative to women wishing to avoid surgical management. It has relatively low risk of complications. Using biochemical markers can potentially help clinicians in counselling women about the likelihood of success of management.