title: Effect of Menstrual Age on Failure of Medical Management in Women With Early Pregnancy Loss.
abstract: OBJECTIVE
  Women with failure of an early pregnancy and a gestational age of <8 weeks are considered good candidates for medical management. The purpose of our study was to evaluate the effect of menstrual age on the outcome of medical management in women with loss of a pregnancy at an estimated gestational age<8 weeks by ultrasound (US).
  
  
  METHODS
  We conducted a retrospective cohort study of all women discharged from the emergency department (ED) between 2011 and 2013 with a diagnosis of early pregnancy failure who were managed with misoprostol and who had a gestational age of <8 weeks on US. We used logistic regression to estimate the effect of menstrual age on failed medical management, defined as requiring dilatation and curettage (D and C) or having an unplanned return to the ED (URED).
  
  
  RESULTS
  Among 823 pregnant women presenting to the ED with first trimester bleeding, 199 had pregnancy failure at <8 weeks by US and were discharged to use misoprostol. Increasing menstrual age was associated with an increased risk of D and C and URED. Specifically, the risk of D and C was 11.8% at <8 weeks, 18.5% at 8 to 9 weeks, 25.3% at 10 to 11 weeks, and 30.6% at ≥12 weeks (P<0.05). The risk of URED was 14.7% at <8 weeks, 27.8% at 8 to 9 weeks, 36.0% at 10 to 11 weeks, and 41.7% at ≥12 weeks (P<0.05).
  
  
  CONCLUSIONS
  Increasing gestational age according to menstrual dates is associated with an increased rate of failed medical management in women with early pregnancy loss, independent of gestational age estimated by ultrasound. Gestational age by menstrual dates should be considered when discussing treatment options with women who have an early pregnancy failure.
authors.affiliation: Department of Obstetrics and Gynaecology, Jewish General Hospital, McGill University, Montreal QC.
authors.forename: Melissa
authors.initials: M
authors.lastname: Lavecchia
authors.affiliation: Department of Obstetrics and Gynaecology, Jewish General Hospital, McGill University, Montreal QC; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montreal QC.
authors.forename: Haim A
authors.initials: HA
authors.lastname: Abenhaim
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal; D000022:Abortion, Spontaneous / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D004107:Dilatation and Curettage; D005260:Female; D005865:Gestational Age; D006801:Humans; D016595:Misoprostol; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012044:Regression Analysis; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: gestational age; misoprostol; prenatal ultrasonography; spontaneous abortion