title: Effect of Uterine Cavity Sonographic Measurements on Medical Management Failure in Women With Early Pregnancy Loss.
abstract: OBJECTIVE
  Medical management is commonly used among women with early pregnancy failure. The purpose of our study was to evaluate uterine content sonographic measurements for predicting medical management failure in early pregnancy loss.
  
  
  METHODS
  We conducted a retrospective cohort study in a university-affiliated hospital center including all women discharged from the emergency department (ED) with a diagnosis of early pregnancy failure who had medical management with misoprostol between 2011 and 2013. Only women with sonograms available for review were included in our study. All images were reviewed and the following cavity measurements, excluding the endometrial lining, were measured: cavity anteroposterior distance, cavity longitudinal distance, cavity transverse distance, and cavity volume. Logistic regression analysis was used to identify measurements that were independently associated with a subsequent need for dilation and curettage (D&C) and an unplanned return to the ED.
  
  
  RESULTS
  Among 823 women presenting to the ED with first-trimester bleeding, 227 met inclusion criteria. Of all measurements evaluated, the cavity anteroposterior distance was found to be independently associated with D&C and an unplanned return to the ED. When a cavity anteroposterior distance cutoff of 15 mm was used, women were more likely to require D&C (adjusted odds ratio, 2.65; 95% confidence interval, 1.31-5.36; P< .01) and to have an unplanned return to the ED (adjusted odds ratio, 2.59; 95% confidence interval, 1.41-4.79; P < .01). In women with a cavity anteroposterior distance of less than 15 mm, 87.1% had successful medical management of early pregnancy loss, and 80.0% did not require an unplanned return to the ED.
  
  
  CONCLUSIONS
  Although there is a need for further validation, patients identified as having a cavity anteroposterior distance of less than 15 mm should be considered good candidates for successful medical management.
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Lavecchia
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Klam
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada haim.abenhaim@gmail.com.
authors.forename: Haim Arie
authors.initials: HA
authors.lastname: Abenhaim
mesh_terms: D000022:Abortion, Spontaneous / Q000628:therapy*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use*; D010120:Oxytocics / Q000627:therapeutic use; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies; D017211:Treatment Failure; D014463:Ultrasonography / Q000379:methods*; D014599:Uterus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol
keywords: abortion; first trimester; incomplete abortion; misoprostol; obstetric ultrasound; sonography; spontaneous abortion