title: MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study.
abstract: OBJECTIVE
  To assess the effectiveness of curettage versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage.
  
  
  METHODS
  We conducted a multicenter cohort study alongside a randomized clinical trial (RCT) between June 2012 until July 2014. 27 Dutch hospitals participated. Women with an incomplete evacuation after misoprostol treatment for first trimester miscarriage who declined to participate in the RCT, received treatment of their preference; curettage (n=65) or expectant management (n=132). A successful outcome was defined as an empty uterus on sonography at six weeks or uneventful clinical follow-up. We furthermore assessed complication rate and (re)intervention rate RESULTS: Of the 197 women who declined to participate in the RCT, 65 preferred curettage and 132 expectant management. A successful outcome was observed in 62/65 women (95%) in the surgical group versus 112/132 women (85%) in the expectant group (RR 1.1, 95% CI 1.03-1.2), with complication rates of 6.2% versus 2.3%, respectively (RR 2.7, 95% CI 0.6-12).
  
  
  CONCLUSIONS
  In women with an incomplete evacuation of the uterus after misoprostol treatment, expectant management is an effective and safe option. This finding could restrain the use of curettage in women that have used misoprostol in the treatment of first trimester miscarriage.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, P.O. Box 22770, 1100 DE Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic address: m.lemmers@amc.uva.nl.
authors.forename: Marike
authors.initials: M
authors.lastname: Lemmers
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, P.O. Box 22770, 1100 DE Amsterdam, The Netherlands.
authors.forename: Marianne A C
authors.initials: MAC
authors.lastname: Verschoor
authors.affiliation: Julius Center for Health Sciences and Primary Care, UMC Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Katrien
authors.initials: K
authors.lastname: Oude Rengerink
authors.affiliation: Julius Center for Health Sciences and Primary Care, UMC Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Christiana
authors.initials: C
authors.lastname: Naaktgeboren
authors.affiliation: Clinical Research Unit, University of Amsterdam, Academic Medical Center, P.O. Box 22770, 1100 DE Amsterdam, The Netherlands.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Bossuyt
authors.affiliation: Department of Obstetrics and Gynaecology, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: Judith A F
authors.initials: JAF
authors.lastname: Huirne
authors.affiliation: Department of Obstetrics and Gynaecology, Groene Hart Ziekenhuis, P.O. Box 1098, 2800 BB Gouda, The Netherlands.
authors.forename: Ineke A H
authors.initials: IAH
authors.lastname: Janssen
authors.affiliation: Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis West, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands.
authors.forename: Celine
authors.initials: C
authors.lastname: Radder
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Klinkert
authors.affiliation: Department of Obstetrics and Gynaecology, Atrium Medical Center, P.O. Box 4446, 6401 CX Heerlen, The Netherlands.
authors.forename: Josje
authors.initials: J
authors.lastname: Langenveld
authors.affiliation: Department of Obstetrics and Gynaecology, Deventer Hospital, P.O. Box 5001, 7400 GC Deventer, The Netherlands.
authors.forename: Lucet
authors.initials: L
authors.lastname: van der Voet
authors.affiliation: Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, P.O. Box 5011, 2600 GA Delft, The Netherlands.
authors.forename: F Frederike
authors.initials: FF
authors.lastname: Siemens
authors.affiliation: Department of Obstetrics and Gynaecology, Maxima Medical Center, Postbus 7777, 5500 MB Veldhoven, The Netherlands.
authors.forename: Marlies Y
authors.initials: MY
authors.lastname: Bongers
authors.affiliation: Department of Obstetrics and Gynaecology, Sint Franciscus Gasthuis, Rotterdam, P.O. Box 10900, 3004 BA Rotterdam, The Netherlands.
authors.forename: Marcel H
authors.initials: MH
authors.lastname: van Hooff
authors.affiliation: Department of Obstetrics and Gynaecology, Martini ziekenhuis Groningen, P.O Box 30033, 9700 RM Groningen, The Netherlands.
authors.forename: Marinus
authors.initials: M
authors.lastname: van der Ploeg
authors.affiliation: Department of Obstetrics and Gynaecology,UMC St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: F P J
authors.initials: FPJ
authors.lastname: Sjors
authors.affiliation: Department of Obstetrics and Gynaecology,UMC St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: S F P J
authors.initials: SFPJ
authors.lastname: Coppus
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, P.O. Box 22770, 1100 DE Amsterdam, The Netherlands.
authors.forename: W M
authors.initials: WM
authors.lastname: Ankum
authors.affiliation: The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 55 King William Road, North Adelaide SA 5006 and The South Australian Health and Medical Research Institute, Adelaide, Australia.
authors.forename: Ben Willem J
authors.initials: BWJ
authors.lastname: Mol
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000027:Abortion, Incomplete / Q000601:surgery / Q000628:therapy*; D000022:Abortion, Spontaneous / Q000188:drug therapy*; D000328:Adult; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use*; D011247:Pregnancy; D016896:Treatment Outcome; D057832:Watchful Waiting
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Curettage; Incomplete evacuation; Miscarriage; Misoprostol