Ultrasonographic endometrial thickness after medical and surgical management of early pregnancy failure.
OBJECTIVE
We sought to compare endometrial thickness after misoprostol or dilation and curettage (D&C) for early pregnancy failure and to assess the predictive value of endometrial thickness for subsequent D&C after misoprostol treatment.


METHODS
In a randomized trial of early pregnancy failure management, 491 women were treated with misoprostol vaginally, and 161 were treated with D&C. Transvaginal ultrasonography was planned for 2 and 14 days after misoprostol treatment, and 14 days after D&C.


RESULTS
The mean endometrial thickness 14 days after treatment was 9.0 mm for the misoprostol group and 6.9 mm for the D&C group, (difference 2.1 mm, 95% confidence interval [CI] 1.0-3.2). After the ultrasonograms 2 and 14 days after misoprostol, 13 (3.8%) and 12 (3.2%) women, respectively, subsequently underwent D&C. Women requiring D&C after successful expulsion had significantly greater endometrial thickness than those who did not at 2 days (mean difference 5.2 mm, 95% CI 1.6-8.8) and 14 days (mean difference 5.5 mm, 95% CI 2.3-8.8) after misoprostol. However, endometrial thickness was a poor predictor of subsequent D&C. The areas under the receiver operating characteristic curves for endometrial thickness at 2 and 14 days were 0.71 and 0.73, respectively. Regardless of cutoff values used for predicting subsequent D&C, endometrial thickness had a positive predictive value of 40% or less.


CONCLUSIONS
The difference in endometrial thickness between misoprostol treatment and D&C for early pregnancy failure is not clinically significant. Endometrial thickness is not a useful predictor of subsequent surgical intervention after successful expulsion of the gestational sac after misoprostol for early pregnancy failure.


BACKGROUND
ClinicalTrials.gov,www.clinicaltrials.gov, NCT00177333


METHODS
I.
Reeves
Matthew F
MF
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. mreeves@upmc.edu
Lohr
Patricia A
PA
Harwood
Bryna J
BJ
Creinin
Mitchell D
MD
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000030:Abortion, Missed / Q000188:drug therapy* / Q000601:surgery*; D000328:Adult; D004107:Dilatation and Curettage; D004717:Endometrium / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014463:Ultrasonography
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol