title: Fertility and obstetric outcomes after curettage versus expectant management in randomised and non-randomised women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage.
abstract: OBJECTIVE
  To assess fertility and obstetric outcomes in women treated with curettage or undergoing expectant management for an incomplete miscarriage after misoprostol treatment.
  
  
  METHODS
  Between June 2012 and July 2014, we conducted a multicentre randomised clinical trial (RCT) with a parallel cohort study for non-randomised women, treated according to their preference. In the RCT 30 women were allocated curettage and 29 expectant management. In the cohort 197 women participated; 65 underwent curettage and 132 women underwent expectant management. Primary outcome was curation, defined as either an empty uterus on sonography at six weeks or an uneventful clinical follow-up. We used questionnaires to assess fertility and obstetric outcome of the first new pregnancy subsequent to study enrolment.
  
  
  RESULTS
  Curation was seen in 91/95 women treated with curettage (95.8%) versus 134/161 women managed expectantly (83.2%) (p=0.003). The response rate was 211/255 (82%). In 198 women pursuing a new pregnancy, conception rates were 92% (67/73) in the curettage group versus 96% (120/125) in the expectant management group (OR 0.96, 95% CI 0.89;1.03, p=0.34), with ongoing pregnancy rates of 87% (58/67) versus 78% (94/120), respectively (OR 1.12, 95% CI 0.99;1.28, p=0.226). Preterm birth rates were 1/46 in the curettage group versus 8/81 in the expectant management group (OR 0.22, 95% CI 0.03;1.71 P=0.15). Caesarean section rates were 23% and 24% for women in the curettage group and expectant management group respectively.
  
  
  CONCLUSIONS
  In women with an incomplete evacuation of the uterus after misoprostol treatment, curettage and expectant management does not lead to different fertility and pregnancy outcomes, as compared to expectant management.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, VU Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: marike.lemmers@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Lemmers
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands.
authors.forename: M A C
authors.initials: MAC
authors.lastname: Verschoor
authors.affiliation: Department of Obstetrics and Gynaecology, VU Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Overwater
authors.affiliation: Clinical Research Unit, University of Amsterdam, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: Bossuyt
authors.affiliation: Department of Obstetrics and Gynaecology, Amphia Ziekenhuis, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Hendriks
authors.affiliation: Department of Obstetrics and Gynaecology, Westfriesgasthuis, P.O. Box 600, 1620AR, Hoorn, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hemelaar
authors.affiliation: Department of Obstetrics and Gynaecology, Isala Kliniek, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Schutte
authors.affiliation: Department of Obstetrics and Gynaecology, Noordwest Ziekenhuisgroep, P.O. Box 501, 1800 AM, Alkmaar, The Netherlands.
authors.forename: A H
authors.initials: AH
authors.lastname: Adriaanse
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands.
authors.forename: W M
authors.initials: WM
authors.lastname: Ankum
authors.affiliation: Department of Obstetrics and Gynaecology, VU Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: J A F
authors.initials: JAF
authors.lastname: Huirne
authors.affiliation: The Robinson Research Institute|School of Medicine, University of Adelaide, The South Australian Health and Medical Research Institute, Adelaide, Australia.
authors.forename: B W J
authors.initials: BWJ
authors.lastname: Mol
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000027:Abortion, Incomplete / Q000601:surgery*; D000022:Abortion, Spontaneous / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D004107:Dilatation and Curettage; D005260:Female; D005298:Fertility; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D016896:Treatment Outcome; D057832:Watchful Waiting
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Curettage; Fertility; Incomplete evacuation; Miscarriage; Misoprostol; Obstetric outcome