Hormone pattern after misoprostol administration for a nonviable first-trimester gestation.
OBJECTIVE
To evaluate serial hormone concentrations in subjects treated with vaginally administered misoprostol for early pregnancy failure.


METHODS
As part of a randomized clinical trial, serum was collected on treatment days 1, 3, 8, and 15.


METHODS
Multicenter clinical trial.


METHODS
Women with a nonviable first-trimester pregnancy.


METHODS
Serum concentrations of human chorionic gonadotropin (hCG), progesterone, and sex hormone binding globulin (SHBG) were evaluated.


METHODS
A logistic regression model was constructed to assess the associations of percent and complete expulsion of the gestational sac and/or successful management.


RESULTS
The percent change from the day of treatment until the first follow-up visit was predictive for complete expulsion for progesterone (P) (P<.005) and hCG (P<.005), but not for SHBG. The actual value was not significantly associated with complete expulsion or successful management. A decrease (day 1-3) of 79% for both hCG and P was associated with a 90% probability of complete passage of the gestational sac. A 90% probability of successful management was noted if P decreased by 78% on day 3 or 59% on day 7, or hCG decreased by 74% on day 3 or 78% on day 7 compared with pretreatment values.


CONCLUSIONS
Percent change, but not absolute change, in serial hormone values are strongly associated with both the complete expulsion of the gestational sac with one dose of misoprostol and ultimate success.
Barnhart
Kurt T
KT
University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104-5509, USA. kbarnhart@mail.obgyn.upenn.edu
Bader
Thomas
T
Huang
Xiangke
X
Frederick
Margaret M
MM
Timbers
Kelly A
KA
Zhang
Jun Jim
JJ
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000022:Abortion, Spontaneous / Q000097:blood* / Q000188:drug therapy*; D000282:Administration, Intravaginal; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D016595:Misoprostol / Q000494:pharmacology*; D009994:Osmolar Concentration; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011374:Progesterone / Q000097:blood*; D019233:Retreatment; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D016896:Treatment Outcome
D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D012738:Sex Hormone-Binding Globulin; D016595:Misoprostol; D011374:Progesterone