title: [Clinical and ultrasonographic factors affecting successful medical treatment of early pregnancy failure].
abstract: OBJECTIVE
  To assess clinical and echocardiographic factors impacting the effectiveness of misoprostol in early pregnancy failure.
  
  
  METHODS
  An observational study was carried out within the gynaecological emergency service from 01/06/2000 to 15/05/2010. Patients had pregnancy failure in the first 12 weeks at ultrasonic examination. The patient received 4 misoprostol tablets (800 μg) intravaginally with clinical and ultrasound examination 24 hours later. The treatment was considered effective if the endometrial thickness was lower than 15 mm by ultrasound examination and absence of secondary endo-uterine aspiration. If the treatment was considered as a failure, an endo-uterine aspiration was carried out. Variables studied were clinical (patient age, date of the last menstrual period, gravidity, parity, history of miscarriage, endouterine aspiration, ectopic pregnancy, vaginal delivery, caesarean section) and ultrasound-based (presence or absence of an embryo, CRL, gestational sac diameter).
  
  
  RESULTS
  Five hundred and one patients were included. The success rate was 336/501 (67.1%). After univariate analysis, the averages of parity (P=0.048) and caesarean section (P=0.002) were significantly higher in failure cases. The history of one or more caesarean section was a significant risk factor for failure (P=0.001). There was no significant difference for the other criteria. In multivariate analysis, the average number of caesarean sections (P=0.003) and the history of one or more caesarean section remained significant (P=0.002).
  
  
  CONCLUSIONS
  The ultrasound criteria and gestational age do not impact the effectiveness of misoprostol in the treatment of early pregnancy failure. The history of one or more caesarean section (s) significantly decreased the success rate. It has to be confirmed by other studies. This new data can be an aid to decision-making for the patient and the physician in case of early pregnancy failure.
authors.affiliation: Service de gynécologie obstétrique, hôpital La Conception, 147, boulevard Baille, 13005 Marseille, France.
authors.forename: N-E
authors.initials: NE
authors.lastname: Menager
authors.forename: D-A
authors.initials: DA
authors.lastname: Loundou
authors.forename: C
authors.initials: C
authors.lastname: Chau
authors.forename: L
authors.initials: L
authors.lastname: Cravello
authors.forename: M
authors.initials: M
authors.lastname: Gamerre
authors.forename: A
authors.initials: A
authors.lastname: Agostini
mesh_terms: D000022:Abortion, Spontaneous / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use*; D010120:Oxytocics / Q000627:therapeutic use*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D010120:Oxytocics; D016595:Misoprostol