title: Medical treatment with misoprostol for early failure of pregnancies after assisted reproductive technology: a promising treatment option.
abstract: OBJECTIVE
  To assess the success rate of misoprostol to induce abortion in early pregnancy failure and to define the factors associated with success of treatment.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  University-affiliated tertiary medical center.
  
  
  METHODS
  Two hundred twenty women with the diagnosis of blighted ovum or missed abortion with a crown-rump length (CRL) up to 25 mm (<9 w).
  
  
  METHODS
  Treatment protocol included two doses of 800 microg misoprostol given vaginally and orally in intervals of 24 to 72 hours.
  
  
  METHODS
  Failure was defined as surgical intervention because of retained gestational sac, severe pain or bleeding, or suspected retained products of gestation after menstruation.
  
  
  RESULTS
  The treatment was successful in 77.2% (170/220) of the patients. Success rate was 72.5% (121/167) for pregnancies achieved spontaneously and 92.4% (49/53) among women who conceived after assisted reproductive technology (relative risk = 3.65: 95% confidence interval 1.378 to 9.667). Multivariate analysis showed that the risk of failure of medical abortion increased significantly for patients who had had at least five previous pregnancies (of them, three or more abortions) as compared with patients with one or two previous pregnancies only, and for those who conceived spontaneously as compared with pregnancies after ovulation induction.
  
  
  CONCLUSIONS
  Medical treatment in early missed abortion is recommended especially for women with low gravidity and for those who conceived after assisted reproductive technology.
authors.affiliation: Department of Obstetrics and Gynecology, affiliated with Sackler School of Medicine, Tel Aviv, Israel. mmachtin@walla.co.il
authors.forename: Ronit
authors.initials: R
authors.lastname: Machtinger
authors.forename: David
authors.initials: D
authors.lastname: Stockheim
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Seidman
authors.forename: Liat
authors.initials: L
authors.lastname: Lerner-Geva
authors.forename: Jehoshua
authors.initials: J
authors.lastname: Dor
authors.forename: Eyal
authors.initials: E
authors.lastname: Schiff
authors.forename: Adrian
authors.initials: A
authors.lastname: Shulman
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000028:Abortion, Induced / Q000379:methods*; D000030:Abortion, Missed / Q000188:drug therapy*; D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D016595:Misoprostol / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol