Incomplete Miscarriage Research Articles

Study on Misoprostol in Case of Missed Abortion

Background: Misoprostol and manual vacuum aspiration (MVA) are both effective treatments for incomplete abortion. Misoprostol, a medication that induces uterine contractions, is often preferred for its non-invasive nature and ease of administration. MVA, a surgical method, involves removing retained products of conception using suction. Studies suggest that while MVA has a higher success rate and faster recovery, misoprostol is a cost-effective, accessible option with fewer complications, though it may require follow-up treatment in some cases. Objective: In this our main goal is to assess the efficiency of misoprostol versus manual vacuum aspiration for the treatment of incomplete abortion. Method: This hospital based randomized controlled trial study was conducted in in-patient patient Department of Obstetrics and Gynaecology, Chittagong Medical College and Hospital from October 2007 to September 2008. A total of 128 women between the age of 15 to 40 years with diagnosis of first trimester uncomplicated spontaneous incomplete abortion was included in this study. Among them 64 patients were randomized in group ‘A’ as case who were treated with Misoprostol and 64 patients were in group ‘B’ as control who were treated with Manual Vacuum Aspiration. Results: During the study, where the mean gestational size of uterus was 9.52 weeks at the time of initial examination. The mean size of uterus in misoprostol group was 9.07(SD ±1.93) and that of MVA group was 9.87 (SD± 1.35). More women in case group had no child of viable age on the other hand increased number of women in control group had at least one viable birth. 36 (60%) out of 60 women in misoprostol group 26 (41.93%) out of 62 reported pain and 36 (58.07%) out of 62 women in MVA and 24 (40%) patients in misoprostol arm said bleeding as the worst feature. Thirty six percent women in misoprostol group and 16% women in MVA group reported that the adverse effects were easily tolerable. Thirty percent women ...

Witzenberg Women's experience of health care after a miscarriage: A descriptive qualitative study.

Although some evidence is available from low- and middle-income countries, no South African data are available on how women experience healthcare during treatment for an incomplete miscarriage. This study sets out to explore and describe the experiences of healthcare among women who suffered an incomplete spontaneous miscarriage in the Witzenberg subdistrict, a rural area in the Western Cape province of South Africa. Witzenberg subdistrict, Western Cape province, South Africa. This study used a descriptive exploratory qualitative study design. In-person interviews were held with women who experienced a miscarriage. Interviews followed a semi-structured format by a single interviewer to explore the various aspects involving experiences of healthcare. Eight interviews were conducted and analysed. The five themes that arose from transcribed data were: (1) a need for safety, (2) pain management, (3) moderating behaviours and attitudes, (4) disorienting healthcare systems and (5) abandonment. Several factors contributed to the loss of physical and emotional safety in the emergency centre environment. Timeous emotional and pharmacological pain management were found to be a gap while patients awaited care. Clear communication and staff attitude were found to be integral to the patient's experience and could avoid the perception of abandonment. There is a universal need for basic respectful, supportive and safe care in patients who attend an emergency centre for early pregnancy complications in rural South African. Specific focus should be given to clear communication and appropriate emotional support during and after the miscarriage.Contribution:This study can be used as a guide to improve services by ensuring respectful, transparent, informed, and appropriate continuity of care.

Resection of uterine arteriovenous fistula with temporary occlusion of the internal iliac arteries: Case series and literature review.

Uterine arteriovenous fistula (UAVF) is a rare vascular abnormality that can cause severe and potentially life-threatening hemorrhage. Uterine artery embolization is a common treatment that may affect ovarian and uterine perfusion and cause fertility problems. We herein report our experience treating 2 patients with UAVF who underwent resection after temporary occlusion of both internal iliac arteries. Both patients presented with a large UAVF after incomplete miscarriages in the second trimester. Magnetic resonance imaging revealed a UAVF measuring 3.6 × 2.6 × 2.1 cm over the myometrium of the posterior uterine in case 1, and a UAVF of 7.1 × 4.1 × 4.5 cm was identified in case 2. Uterine arteriovenous fistula, retained products of conception. The patients underwent resection of UAVF with temporary occlusion of the internal iliac arteries and hysteroscopic removal of the retained products of conception. Intraoperative bleeding were minimal. Neither patient exhibited abnormal uterine bleeding at the 6-month follow-up. Follow-up ultrasonography and magnetic resonance imaging showed normal uterine myometrium and endometrium and no residual disease. UAVF resection after temporary occlusion of the internal iliac arteries is a promising treatment approach for UAVF. This technique can reduce intraoperative bleeding and remove the potential hemorrhage-related lesion while preserving fertility.

Predictors of successful expectant and medical management of miscarriage: A systematic review.

15.3% of pregnancies result in miscarriage, management options include expectant, medical, or surgical. However, each patient has a range of variables, which makes navigating the available literature challenging when supporting individual patient decision-making. This systematic review aims to investigate whether there are any specific predictors for miscarriage management outcome. The following databases were searched, from the start of each database up to April 2023: PubMed, Medline, and Google Scholar. Inclusion criteria were studies interrogating defined predictors for expectant or medical management of miscarriage success. Exclusion criteria were poor quality, review articles, trial protocols, and congress abstracts. Data collection was carried as per PRISMA guidelines. Quality assessment for each study was assessed using the QUIPS proforma. Relevant predictors include demographics, ultrasound features, presenting symptoms, and biochemical markers. Across the 24 studies there is heterogeneity in miscarriage definition, predictors reported, and management outcomes used. Associations with certain variables and miscarriage management outcomes are described. Ten studies assessed the impact of miscarriage type on expectant and/or medical management. The majority found that a diagnosis of incomplete miscarriage had a higher success rate following expectant or medical management compared to missed miscarriage or anembryonic pregnancy. We conclude that there is evidence supporting the possibility to offer personalized miscarriage management advice with case specific predictors. Further larger studies with consistent definitions of predictors, management, and outcomes are needed in order to better support women through the decision-making of miscarriage management.

Optimization of intrauterine interventions in spontaneous abortion

Introduction. Retained products of conception (RPOC) are detected in 15 % of women after spontaneous or medical abortion. RPOC blind removal from the uterine cavity remains the "gold standard" of surgical treatment, which, however, may be associated with a high risk of certain complications that pose a serious threat to female reproductive function and quality of life. An alternative method for eliminating RPOC proposed by operative hysteroscopy demonstrating the visual control advantages.Aim: to evaluate clinical effectiveness and safety of RPOC removal in incomplete spontaneous abortion using hysteroscopic morcellation.Materials and Methods. The prospective comparative study included 135 women with incomplete spontaneous abortion aged 18 to 40 years, divided into 3 groups: group 1 – 42 patients after RPOC electromechanical vacuum aspiration (EVA); group 2 – 44 patients after RPOC manual vacuum aspiration (MVA); group 3 – 49 patients after RPOC hysteroscopic morcellation (HM). In all patients, the level of total endotoxin was measured, metroaspirate cytokine profile was analyzed, the indicator of endometrial microcirculation was assessed before surgical treatment and on day 1 afterwards, and genital ultrasound examination was performed on day 3–5 post-surgery.Results. In the post-surgical vs. pre-treatment period, the EVA and MVA groups revealed significantly increased levels of total endotoxin and interleukin (IL) IL-1β (p < 0.05). In contrast, these parameters in the HM group changed insignificantly (p > 0.05). In all groups, IL-8 and tumor necrosis factor alpha (TNF-α) levels after surgery were significantly elevated (p = 0.001). In the EVA and MVA groups, levels of anti-inflammatory cytokines IL-4 and IL-10 were markedly decreased (p = 0.001), which did not change in the HM group (p > 0.05). A significantly accelerated microcirculation rate was noted in the EVA and MVA groups while comparing it at pre-surgery level (p = 0.001), but not in the HM group (p = 0.415). Incomplete RPOC removal was reported for 4.5 % MVA patients, all EVA and HM patients had total RPOC elimination. Intraoperative bleeding, uterine perforation were not reported in any examined patient.Conclusion. The early-stage treatment results showed that RPOC removal by the HM is an effective and safe approach. Limited inflammatory response and stable endometrial microcirculation upon using the HM evidence about a minimal impact on the endometrium that lowers probability of postoperative adhesion.

P-409 Intrauterine adhesion in Ultrasound-guided manual vacuum aspiration (USG-MVA) versus electric vacuum aspiration (EVA): a randomized controlled trial

Abstract Study question Does ultrasound-guided manual vacuum aspiration (USG-MVA) have a lower incidence of intrauterine adhesion (IUA) compared to conventional surgical evacuation? Summary answer The rate of intrauterine adhesion following ultrasound-guided manual vacuum aspiration (USG-MVA) was significantly lower compared to conventional surgical evacuation (EVA). What is known already Miscarriages are common in pregnant women and can be managed through conservative, medical, or surgical approaches. Traditional surgical evacuation for early pregnancy loss involves electric vacuum aspiration (EVA) under general anesthesia. However, manual vacuum aspiration (MVA) offers a cost-effective, portable, and easy-to-administer alternative. MVA has shown high effectiveness and minimal complications. By incorporating ultrasound guidance (USG), MVA can further reduce discomfort and minimize the risk of future intrauterine adhesions (IUA) due to its protective effect on the endometrium. However, the incidence of IUA after USG-MVA is still not known. Study design, size, duration This was a prospective single-centre, randomised controlled trial conducted in a university-affiliated tertiary hospital from May 2019 to September 2022. Patients were randomized into USG-MVA group or the EVA group. They were invited to come back for a hysteroscopic assessment for IUA at 6-20 weeks post-surgery to assess the incidence of IUA. Patients were contacted by phone at 6 months to assess their menstrual and reproductive outcomes. Participants/materials, setting, methods Chinese women aged ≥18 with a delayed miscarriage of up to 12 weeks of gestation or an incomplete miscarriage were randomly assigned to receive either USG-MVA or EVA for their miscarriage management. An outpatient hysteroscopy was conducted by a team of experienced gynecologists who had comparable surgical expertise within a timeframe of 6 to 20 weeks from USG-MVA or EVA. These gynecologists were unaware of the women’s initial surgical procedure performed for the first-trimester miscarriage. Main results and the role of chance This study included 303 patients who underwent surgical evacuation, with 152 receiving USG-MVA and 151 receiving EVA. Hysteroscopic assessments were completed by 126 patients in the USG-MVA group and 125 patients in the EVA group. The incidence of IUA was statistically (p < 0.02) lower in the USG-MVA group (19.0% ) when compared to the EVA group (32.0%). Interestingly, although there was no significant difference in menstrual outcomes at 6 months postoperatively between the two groups, a higher number of patients in the EVA group with IUA experienced subsequent miscarriages. Hysteroscopic adhesiolysis was performed during hysteroscopy when it is diagnosed to restore uterine cavity. XX USG-MVA patients underwent hysteroscopic adhesiolysis, compared to 36 patients in the EVA group. Two patients in the EVA group required additional treatment in the operating theatre or as an outpatient, and one patient did not follow-up as scheduled. The EVA group had a higher proportion of patients with hypomenorrhea among those who had previous intrauterine surgeries compared to the USG-MVA group, although this difference was not statistically significant. Overall, USG-MVA appears to be a more effective and safer option for managing early pregnancy loss due to its lower incidence of IUA and potential reduction in subsequent miscarriages. Limitations, reasons for caution Performing USG-MVA, as opposed to a blind MVA procedure, however, requires additional equipment and staff with appropriate training. There is no direct comparison between MVA and EVA with USG. The study only followed patients up to 6 months post-operation, which cannot further assess their fertility outcomes. Wider implications of the findings USG-MVA offers cost savings and increased patient comfort by being performed in an outpatient setting. Shifting procedures from the operating room to ambulatory settings reduces expenses and allows patients to avoid general anesthesia, promoting autonomy and quicker recovery. Trial registration number ChiCTR1900023198

Viable cesarean scar pregnancy from primary care perspective: A case report

Ectopic pregnancies within previous cesarean section scars are rare but potentially life-threatening complications. Diagnosis can be challenging, particularly in primary care settings, where the focus is often on routine primary care services. We present a case report of a patient who initially presented to a primary care clinic with non-specific symptoms of ectopic pregnancy and was referred to a tertiary center for incomplete miscarriage. It was found to be a viable ectopic pregnancy within a cesarean scar. This case highlights the importance of keeping an open mind in patients with a history of cesarean section and uterine manipulation procedures such as manually evacuating a retained placenta. It emphasizes prompt diagnosis and referral to a specialized healthcare facility.

The prevalence of molar pregnancy among patients with incomplete miscarriage at a maternity teaching hospital

Background and objective: Gestational trophoblastic disease (GTD) involves a range of interrelated disorders that originate from the placenta; it can be benign or malignant. In the Kurdistan region of Iraq, data about GTD and its consequences is scarce. This study aims to identify the prevalence of GTD and its types among a cohort of Kurdish women. Methods: A cross-sectional study was conducted for a one-year duration from April 1, 2020, to April 1, 2021, at the Emergency Department of Maternity Teaching Hospital, Erbil City. Pregnant women in their first trimester and early second trimester (4–14 weeks of gestation) with vaginal bleeding, pregnant women with vaginal bleeding due to incomplete miscarriage, and pregnant women with a history of missed miscarriage were included in the study. A specialized questionnaire was prepared for the purpose of data collection. Results: Out of 380 incomplete miscarriage cases who were interviewed, fifty patients with gestational trophoblastic disease were included in the current study. The prevalence of GTD was 13.1%, and the majority of patients had a partial type of GTD. The current analysis indicated that there was a statistically significant association between the types of GTD, the personal history of molar pregnancy, and the age of participants. The analysis indicated that there is no statistical association between parity, blood group, and history of miscarriage and the type of GTD. Conclusion: The prevalence of GTD was remarkably high, and the partial type of GTD was the most common form present among the participants. The majority of the cases were diagnosed during the first trimester of the pregnancy. Complete GTD was more common among patients of advanced age.

Medical management of early pregnancy loss with mifepristone and misoprostol in emergency departments compared to a Complex Family Planning office: Implementation of a COVID-19 institutional policy change

ObjectivesTo evaluate the implementation of mifepristone and misoprostol for medical management of early pregnancy loss (EPL) in emergency departments (EDs) by comparing efficacy, complication, and follow-up rates for patients treated in EDs to those in the Complex Family Planning (CFP) outpatient office. Study DesignIn COVID-19's first wave, we expanded medication management of EPL to our EDs. This retrospective study evaluated 72 patients receiving mifepristone and misoprostol for EPL from 4/1/2020-3/31/2021, comparing treatment success, safety outcomes, and follow-up rates by location. We did not perform a power calculation. ResultsThirty-three (46%) patients received care in the ED and 39 (54%) at CFP. Treatment success was lower in the ED (23, 70%) compared to CFP (34, 87.2%), but after adjusting for insurance status and type of pregnancy (miscarriage, uncertain viability, unknown location) this was not significant: aOR 0.48 (95%CI 0.13-1.81), p=0.28. More ED patients underwent emergent interventions (3 vs 0). Complications in the ED cohort included two emergent uterine aspirations, one uterine artery embolization, and two blood transfusions. Among these, two cases were attributed to misdiagnosis (a cesarean scar and a cervical ectopic pregnancy interpreted as incomplete miscarriages) and one to guideline nonadherence (anticoagulated patient). No complications occurred in the CFP group. Follow-up rates were over 80% in both groups. More ED patients engaged in telehealth follow-up (67% vs 18.0%, p≤0.0001). ConclusionsIn this small sample, we observed a trend toward lower rates of treatment success following medication management of EPL in the ED, compared to the CFP office. This analysis highlights that both correctly making uncommon diagnoses and adhering to new guidelines presented challenges during our implementation process. IMPLICATIONSImplementing mifepristone and misoprostol for EPL in our EDs achieved lower rates of pregnancy resolution compared to outpatient management. Complex uncommon diagnoses and implementing new care pathways in EDs may have contributed to complications and highlight opportunities for improvement. Additional studies are needed to further quantify safety outcomes for EPL management in EDs. TWEETABLE ABSTRACTED provision of mifepristone and misoprostol for early pregnancy loss during COVID-19 was less effective than outpatient care. There were more serious complications in the ED group due to misdiagnosis and guideline nonadherence.

Retraction.

Retraction: Ali, M. K., Eman, S. M., Abdel-Aleem, M. A., Sobh, A. M. A. Misoprostol versus expectant management in women with incomplete first-trimester miscarriage after failed primary misoprostol treatment: A randomized clinical trial. International Journal of Gynecology & Obstetrics, 154: 558-564. https://doi.org/10.1002/ijgo.13652. The above article, published online on 22 February 2021 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Professor Michael Geary, the International Federation of Gynecology and Obstetrics, and John Wiley and Sons Ltd. Concerns were raised by a third party about inconsistencies in the data and study design of this article and the authors were asked to provide an explanation. Following the authors' response, an independent review concluded that there were inconsistencies in the sample sizes reported in the manuscript, and between the manuscript and the trial registry. There was also a change in the primary outcome in the trial registry that was not reported in the manuscript. Therefore, the parties agreed that the article must be retracted. The authors were notified about the retraction but did not respond.

Intrauterine adhesion in ultrasound-guided manual vacuum aspiration (USG-MVA) versus electric vacuum aspiration (EVA): a randomised controlled trial

BackgroundIntrauterine adhesion (IUA) can arise as a potential complication following uterine surgery, as the surgical procedure may damage the endometrial stratum basalis. The objective of this study was to assess and compare the occurrence of IUA in women who underwent ultrasound-guided manual vacuum aspiration (USG-MVA) versus electric vacuum aspiration (EVA) for managing first-trimester miscarriage.MethodsThis was a prospective, single-centre, randomised controlled trial conducted at a university-affiliated tertiary hospital. Chinese women aged 18 years and above who had a delayed or incomplete miscarriage of ≤ 12 weeks of gestation were recruited in the Department of Obstetrics and Gynaecology at the Prince of Wales. Recruited participants received either USG-MVA or EVA for the management of their miscarriage and were invited for a hysteroscopic assessment to evaluate the incidence of IUA between 6 and 20 weeks after the surgery. Patients were contacted by phone at 6 months to assess their menstrual and reproductive outcomes.Results303 patients underwent USG-MVA or EVA, of whom 152 were randomised to ‘USG-MVA’ and 151 patients to the ‘EVA’ group. Out of the USG-MVA group, 126 patients returned and completed the hysteroscopic assessment, while in the EVA group, 125 patients did the same. The incidence of intrauterine adhesion (IUA) was 19.0% (24/126) in the USG-MVA group and 32.0% (40/125) in the EVA group, showing a significant difference (p < 0.02) between the two groups. No significant difference in the menstrual outcomes at 6 months postoperatively between the two groups but more patients had miscarriages in the EVA group with IUA.ConclusionsIUAs are a possible complication of USG-MVA. However, USG-MVA is associated with a lower incidence of IUA postoperatively at 6–20 weeks. USG-MVA is a feasible, effective, and safe alternative surgical treatment with less IUA for the management of first-trimester miscarriage.Trial registrationThe study was registered with the Centre for Clinical Research and Biostatics- Clinical Trials Registry (CCRBCTR), which is a partner registry of the WHO Primary Registry-Chinese Clinical Trials Registry (ChiCTR) (Unique Trial Number: ChiCTR1900023198 with the first trial registration date on 16/05/2019)

Uterine Perforations Post-Manual Vacuum Aspiration: A Time for Re-Training

Manual vacuum aspiration (MVA) is the recommended surgical procedure for early miscarriages. Yet, its performance by unqualified and inexperienced hands without minimal medical knowledge and skills in the societies of developing nations is not uncommon. This can present some serious life threatening but preventable complications like uterine perforation with resultant intra-abdominal organ injuries that require surgical intervention. General awareness and retraining may decrease unsafe practices and thus reduce maternal morbidity and mortality. We present two cases of young multiparous women who underwent MVA for incomplete miscarriages, which were complicated by anterior and multiple fundal uterine perforations and resultant gangrenous bowel evisceration and entrapment respectively.

#250 : Patient Satisfaction with Ultrasound-Guided Manual Vacuum Aspiration in the Management of First Trimester Pregnancy Loss

Background: Ultrasound-guided manual vacuum aspiration (USG-MVA) has been shown to be safe and effective alternative to traditional surgical evacuation in managing first trimester pregnancy loss. This study aims to determine patient satisfaction and acceptability of USG-MVA for the management of their first-trimester miscarriage. Methods: This was a single-center cross-sectional study conducted in a university-affiliated tertiary hospital. Patients with delayed miscarriage of [Formula: see text]12 weeks of gestation or incomplete miscarriage who underwent USG-MVA were invited to complete a questionnaire 2-hour post-procedure to evaluate their experience. The Client Satisfaction Questionnaire-8 (CSQ-8) was used to assess patient satisfaction and acceptability to USG-MVA in addition to questions evaluating patient’s perception to the procedure. Results: From 2018 to 2023, a total of 137 patients were recruited and all of which completed the questionnaire. Results indicate that patients were highly satisfied with the procedure, with CSQ-8 mean scores of 27 (SD 3.3, range 14-32). 135 (98.5%) patients were satisfied with the procedure, 129 (94.2%) of patients would wish to choose USG-MVA if they required surgical evacuation again and 128 (93.4%) patients would recommend USG-MVA to a friend. Conclusions: USG-MVA is a feasible, effective, safe and highly acceptable alternative to surgical treatment for the management of first-trimester miscarriage. The option of USG-MVA can be presented as a treatment option when counselling for the management of first trimester miscarriage.

How to Minimize Future Fertility Risks Associated with the Surgical Management of Miscarriage

Miscarriage is a distressing event that can have a profound and lasting impact on a woman’s physical and emotional well-being. Although the causes of miscarriage are not always clear, it is estimated that up to 20% of all pregnancies end in miscarriage. After a miscarriage, women may experience a range of emotions, including grief, guilt, and anxiety. In some cases, medical intervention may be necessary to remove any remaining tissue from the uterus, prevent infection, and reduce the risk of complications. Surgical management is often recommended for incomplete or recurrent miscarriage. However, traditional surgical procedures can lead to the development of intrauterine adhesions, which can cause further complications and fertility problems. Intrauterine adhesions occur when scar tissue forms inside the uterus, usually as a result of damage to the uterine lining. This can cause the walls of the uterus to stick together, making it difficult for a fertilized egg to implant and grow, and potentially leading to infertility. To minimize the risk of intrauterine adhesions and preserve future fertility, ultrasound-guided manual vacuum aspiration (USG-MVA) has been developed as an alternative approach to traditional surgical management of miscarriage. USG-MVA is a minimally invasive procedure that involves using a handheld syringe to remove any remaining tissue from the uterus under ultrasound guidance. The use of ultrasound guidance ensures accurate catheter placement, leading to complete evacuation of the uterine contents and minimizing discomfort by reducing the number of suction catheters passes and unnecessary endometrial damage. USG-MVA has been shown to be a safe and effective method for managing miscarriages while preserving future fertility. The procedure is effective and can be performed in an outpatient setting, reducing the need for hospitalization, and minimizing associated costs. Additionally, USG-MVA has been found to have a lower risk of intrauterine adhesions compared to traditional surgical evacuation.

#87 : Intrauterine Adhesion in Ultrasound-Guided Manual Vacuum Aspiration (USG-MVA) Versus Electric Vaccum Aspiration (EVA): A Randomized Controlled Trial

Background and Aims: Intrauterine adhesion (IUA) is a possible complication after uterine surgery, especially after sharp curettage for miscarriages as it destroys the endometrial stratum basalis. This study aimed to determine and compare the IUA in women who underwent ultrasound-guided manual vacuum aspiration (USG-MVA) as opposed to traditional surgical evacuation (EVA) for the management of their first-trimester miscarriage. Methods: This was a prospective single-centre, randomised controlled trial conducted in a university-affiliated tertiary hospital. Chinese women aged [Formula: see text]18 years with a delayed miscarriage [Formula: see text]12 weeks of gestation or incomplete miscarriage attending the hospital were randomized to either USG-MVA or EVA for the management of their miscarriage. They were invited to come back for a hysteroscopic assessment for IUA at 6-20 weeks post-surgery to assess the incidence of IUA. Patients were contacted by phone at 6 months to assess their menstrual and reproductive outcomes. Results: 303 patients underwent surgical evacuation, of whom 152 were randomized to the ‘USG-MVA’ and 151 patients to the ‘EVA’. 126 from the USG-MVA group and 125 from the EVA group returned and completed the hysteroscopic assessment. The incidence of the IUA from USG-MVA was 19.0% (n=24/126) and was significantly lower compared to EVA, which was at 32.0% (n=40/125). There was no significant difference in menstrual outcomes at 6 months postoperatively between the two groups, but more patients had miscarriages in the EVA group with IUA. Conclusions: IUAs are a possible complication of USG-MVA. However, USG-MVA is associated with a lower incidence of IUA postoperatively at 6-20 weeks. USG-MVA is a feasible, effective, and safe alternative surgical treatment with less IUA for the management of first-trimester miscarriage.

Efficacy, Safety, and Acceptability of Misoprostol in the Treatment of Incomplete Miscarriage: A Systematic Review and Meta-analysis.

To assess the efficacy, safety, and acceptability of misoprostol in the treatment of incomplete miscarriage. The PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Clinical Trials databases (clinicaltrials.gov) were searched for the relevant articles, and search strategies were developed using a combination of thematic Medical Subject Headings terms and text words. The last search was conducted on July 4, 2022. No language restrictions were applied. Randomized clinical trials with patients of gestational age up to 6/7 weeks with a diagnosis of incomplete abortion and who were managed with at least 1 of the 3 types of treatment studied were included. A total of 8,087 studies were screened. Data were synthesized using the statistical package Review Manager V.5.1 (The Cochrane Collaboration, Oxford, United Kingdom). For dichotomous outcomes, the odds ratio (OR) and 95% confidence interval (CI) were derived for each study. Heterogeneity between the trial results was evaluated using the standard test, I2 statistic. When comparing misoprostol with medical vacuum aspiration (MVA), the rate of complete abortion was higher in the MVA group (OR = 0.16; 95%CI = 0.07-0.36). Hemorrhage or heavy bleeding was more common in the misoprostol group (OR = 3.00; 95%CI = 1.96-4.59), but pain after treatment was more common in patients treated with MVA (OR = 0.65; 95%CI = 0.52-0.80). No statistically significant differences were observed in the general acceptability of the treatments. Misoprostol has been determined as a safe option with good acceptance by patients.

Clinico-Demographic profile of incomplete miscarriage at National Referral Hospital, Bhutan

Introduction: Miscarriage is a leading health concern that causes maternal morbidity and mortality. According to the World Health Organization (WHO), the incidence of miscarriage is 39 per 1000 women aged between 15-49 years. There is no reliable information regarding miscarriage in Bhutan. This investigation attempts to study the clinical and demographic profile of incomplete miscarriages and their outcome at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Bhutan. Methods: An observational study was carried out from February 2020 to February 2021 including 132 women with incomplete miscarriage at JDWNRH. Purposive sampling was done and patient with incomplete miscarriage presenting to the JDWNRH was interviewed using structured questionnaire after diagnosis or before they were discharged from hospital. Results: The study found that the proportion of incomplete miscarriage was 25.4 per 1000 pregnant women at JDWNRH. The common age group was 21-30 years with a mean age of 29.9 years. Of them, 65.91% were married, 55.3% had a stable job and 90% were gravida 2 and above. Nearly 80% reported that it was an unplanned pregnancy and 73.5% due to lack of awareness of contraceptive use. Nearly 92% required hospital admission and 88.64% received surgical management. Conclusions: Women with incomplete miscarriages had mostly unintended pregnancies. The majority had surgical management with no mortality.

Failure Rate of Medical Treatment for Miscarriage Correlated with the Difference between Gestational Age According to Last Menstrual Period and Gestational Size Calculated via Ultrasound.

Objective: To study whether the interval between gestational age calculated using the last menstrual period (GA-LMP) and gestational age calculated via ultrasound (GA-US) is correlated with the success rate of medical treatment in cases of miscarriages. Methods: This was a retrospective cohort study conducted in a gynecology unit in a tertiary medical center. Women who underwent medical treatment with Misoprostol for miscarriage at the Edith Wolfson Medical Center between 07/2015 and 12/2020 were included. Incomplete or septic miscarriages, multiple pregnancies, patients with irregular periods, and cases of missing data were excluded. Failure of medical treatment was defined as the need for surgical intervention due to a retained gestational sac, severe bleeding or retained products of conception. The cohort study was divided into two groups: patients with successful treatment and patients for whom surgical intervention was eventually needed. We performed both a univariate and multivariate analysis in order to identify whether a correlation between GA-LMP and GA-US interval is indeed a factor in the success rate of a medical abortion. Results: Overall, 778 patients were included in the study. From this cohort 582 (74.9%) had undergone a successful medical treatment, while 196 (25.1%) required surgical intervention due to the failure of medical treatment, as defined above. The GA-LMP to GA-US interval (in weeks) was 2.6 ± 1.4 in the success group, while the GA in the failure group was 3.1 ± 1.6 (p < 0.001). After performing a multivariant regression analysis, we were able to show that the GA-LMP to GA-US interval was found to be independently correlated with an increase in the treatment failure rate (aOR = 1.24, CI 95% (1.01-1.51), p = 0.03). Conclusions: In cases of miscarriage, longer GA-LMP to GA-US interval has been shown to be an independently correlated factor to lower success rate of the medical treatment option.

Manual Vacuum Aspiration Versus Expectant Management for First Trimester Miscarriage: A Randomized Controlled Trial.

Background Miscarriage is one of the common problems encountered in pregnancy. The treatment modalities are expectant, medical, and surgical management. This study compared the effectiveness and safety of manual vacuum aspiration (MVA) with expectant management for first trimester miscarriage. Method This randomized controlled trial was conducted in Teaching Hospital Jaffna, Jaffna, Sri Lanka, and 134 eligible patients with first trimester spontaneous miscarriage were randomized to expectant management (67) and MVA (67). Those allocated to expectant management were managed expectantly for up to two weeks, and those allocated to MVA underwent aspiration under a paracervical block in the ward. The primary outcome was complete evacuation of the uterus, and the secondary outcomes were duration of bleeding, duration of pain, level of pain, need for the second procedure, cervical or uterine injuries, and patient satisfaction. Results Of the 134 eligible women, seven were lost to follow-up and 127 were analyzed. The MVA was superior in achieving complete evacuation compared to expectant management (95.2% vs. 70.3%; p ≤ 0.001). Notably, in both groups, complete evacuation was more readily achievable in incomplete miscarriage than in missed miscarriage. Duration of bleeding (mean days, 1.6 vs. 4.3; p ≤ 0.0001), duration of pain (mean days, 1.0 vs. 4.2; p ≤ 0.0001), and the need for additional surgical procedure in the form of dilatation and curettage (4.8% vs. 29.7%; p ≤ 0.001) were lower in MVA. Patient satisfaction was higher in the MVA group than in the expectant group (93.7% vs. 65.6%; p ≤ 0.001). No statistically significant differences were observed between the groups in terms of blood transfusion and infection. There wasn't any incidence of cervical damage or uterine perforation. Conclusion MVA is an effective and safe treatment method for first trimester miscarriage with higher patient satisfaction.

Epidemiology of spontaneous pregnancy loss in Kazakhstan: A national population-based cohort analysis during 2014-2019 using the national electronic healthcare system.

Spontaneous pregnancy loss (SPL) is a common health problem that affects 1:10 of childbearing women, and is linked with physical and psychological complications. As the number of nationwide studies on the incidence of SPL is few, especially from middle-income countries, in this study we investigated the epidemiology, complications and outcomes of SPL before 22 weeks of gestation by analyzing large-scale healthcare data from the Unified Nationwide Electronic Healthcare System (UNEHS) in Kazakhstan. A population-based study among women who experienced SPL in any healthcare setting of the Republic of Kazakhstan during the period of 2014-2019. The International Classification of Diseases (ICD) 10th edition and ICD 9th edition's procedural codes were utilized to retrieve data using relevant diagnostic and procedural codes. In total, 207 317 records of women who have experienced an SPL before 22 weeks of gestation were analyzed from all Kazakhstani regions. The estimated prevalence of SPL was 8.7%, with a 20% decline over a 6-year period. The SPL cases ratio comprises on average 6.2 per 1000 reproductive-age women. Incomplete miscarriage (ICD-10 code "O03.4") was the most common type (37.8%), followed by blighted ovum (ICD-10 code "O02.0"; 34.1%) and missed abortion (ICD-10 code "O02.1"; 13.5%). The most common management methods were dilation and curettage of the uterus (ICD-9 code "69.0"; 84.7%) and aspiration curettage of the uterus (ICD-9 code "65.0"; 15%), whereas medical management was rarely performed (2.6%). The information available in UNEHS adequately identifies types of miscarriages and treatment methods. Although the prevalence of SPL before 22 weeks of gestation is decreasing, management of miscarriages requires closer attention.