Medical treatment with misoprostol for early failure of pregnancies after assisted reproductive technology: a promising treatment option.
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.
Machtinger
Ronit
R
Department of Obstetrics and Gynecology, affiliated with Sackler School of Medicine, Tel Aviv, Israel. mmachtin@walla.co.il
Stockheim
David
D
Seidman
Daniel S
DS
Lerner-Geva
Liat
L
Dor
Jehoshua
J
Schiff
Eyal
E
Shulman
Adrian
A
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
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol