title: Medical management of early pregnancy failure (EPF): a retrospective analysis of a combined protocol of mifepristone and misoprostol used in clinical practice.
abstract: OBJECTIVE
  To evaluate the efficacy of a combined protocol of mifepristone and misoprostol in the management of early pregnancy failure (EPF) and the average time to expulsion of tissue and rate of side effects.
  
  
  METHODS
  Retrospective chart review of all consecutive women treated with primary medical management for EPF at our institution from 2006 to 2012.
  
  
  RESULTS
  168 patients were included in the present study. The overall success rate, defined as the absence of the need for surgical intervention, was 61 % and did not differ by calendar year. There was no difference in success rate grouped by diagnosis [intrauterine embryonic/fetal demise (IUED/IUFD) vs. anembryonic gestation; p = 0.30] or gestational age (<9 or ≥9 weeks; p = 0.48). The success rate varied significantly according to the required dose of misoprostol, ≤800 or >800 μg (68 vs. 50 %, p = 0.029). Of the possible predictive factors of success, only the dose of misoprostol required was a significant independent negative predictor. Mean and median time to tissue expulsion after the first dose of misoprostol were 8.4 and 5.5 h, respectively. The incidence of side effects was low with no blood transfusions required.
  
  
  CONCLUSIONS
  The success rate in this study is markedly below published data. This can possibly be attributed to retrospective study design, allowing for physician subjectivity and patients' wishes in the absence of strict study requirements. The protocol was well tolerated with a paucity of side effects. We make suggestions for enhancing success rates in the clinical setting by optimizing medication protocols, establishing precise treatment guidelines and training physicians in the accurate interpretation of treatment outcomes.
authors.affiliation: Department of Gynecologic Endocrinology and Reproductive Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: Valeria
authors.initials: V
authors.lastname: Colleselli
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Schreiber
authors.forename: Elisabeth
authors.initials: E
authors.lastname: D'Costa
authors.forename: Stephanie
authors.initials: S
authors.lastname: Mangesius
authors.forename: Ludwig
authors.initials: L
authors.lastname: Wildt
authors.forename: Beata E
authors.initials: BE
authors.lastname: Seeber
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000022:Abortion, Spontaneous / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015735:Mifepristone / Q000627:therapeutic use*; D016595:Misoprostol / Q000627:therapeutic use*; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol; D015735:Mifepristone