title: Marked improvement in the success rate of medical management of early pregnancy failure following the implementation of a novel institutional protocol and treatment guidelines: a follow-up study.
abstract: To analyze the success rate, time to passage of tissue and subjective patient experience of a newly implemented protocol for medical management of early pregnancy failure (EPF) over a 2-year period.
  
  
  
  A retrospective chart review of all patients with early pregnancy failure primarily opting for medical management was performed. 200 mg mifepristone were administered orally, followed by a single vaginal dose of 800 mcg misoprostol after 36-48 h. We followed-up with our patients using a written questionnaire.
  
  
  
  167 women were included in the present study. We observed an overall success rate of 92 %, defined as no need for surgical management after medication administration. We could not identify predictive values for success in a multivariate regression analysis. Most patients (84 %) passed tissue within 6 h after misoprostol administration. The protocol was well tolerated with a low incidence of side effects. Pain was managed well with sufficient analgesics. Responders to the questionnaire felt adequately informed prior to treatment and rated their overall experience as positive.
  
  
  
  The adaption of the institutional medical protocol resulted in a marked improvement of success rate when compared to the previously used protocol (92 vs. 61 %). We credit this increase to the adjusted medication schema as well as to targeted physician education on the expected course and interpretation of outcome measures. Our results underscore that the medical management of EPF is a safe and effective alternative to surgical evacuation in the clinical setting.
authors.affiliation: Department of Gynecology and Obstetrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: V
authors.initials: V
authors.lastname: Colleselli
authors.affiliation: Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Nell
authors.affiliation: Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Bartosik
authors.affiliation: Department of Gynecology and Obstetrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Brunner
authors.affiliation: Department of Gynecology and Obstetrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Ciresa-Koenig
authors.affiliation: Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Wildt
authors.affiliation: Department of Gynecology and Obstetrics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Marth
authors.affiliation: Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. beata.seeber@i-med.ac.at.
authors.forename: B
authors.identifier: 0000-0002-8224-4126
authors.initials: B
authors.lastname: Seeber
mesh_terms: D000019:Abortifacient Agents / Q000008:administration & dosage*; D000022:Abortion, Spontaneous / Q000188:drug therapy*; D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015735:Mifepristone / Q000008:administration & dosage*; D016595:Misoprostol / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012189:Retrospective Studies
chemical_list: D000019:Abortifacient Agents; D016595:Misoprostol; D015735:Mifepristone
keywords: Early pregnancy failure; Medical management; Mifepristone; Misoprostol