TY - JOUR
T1 - MisoREST
T2 - Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study
AU - Lemmers, Marilee
AU - Verschoor, Marianne A. C.
AU - Rengerink, Katrien Oude
AU - Naaktgeboren, Christiana
AU - Bossuyt, Patrick M.
AU - Huirne, Judith A. F.
AU - Janssen, Ineke A. H.
AU - Radder, Celine
AU - Klinkert, Ellen. R.
AU - Langenveld, Josje
AU - van der Voet, Lucet
AU - Siemens, E. Frederike
AU - Bongers, Marlies Y.
AU - van Hooff, Marcel H.
AU - van der Ploeg, Marinus
AU - Sjors, F. P. J.
AU - Coppus, S. F. P. J.
AU - Ankum, W. M.
AU - Mol, Ben Willem J.
AU - MisoREST Study Grp
PY - 2017/4
Y1 - 2017/4
N2 - 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.Study design: 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 rateResults: 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).Conclusion: 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. (C) 2017 Elsevier B.V. All rights reserved.
AB - 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.Study design: 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 rateResults: 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).Conclusion: 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. (C) 2017 Elsevier B.V. All rights reserved.
KW - Misoprostol
KW - Curettage
KW - Miscarriage
KW - Incomplete evacuation
KW - RANDOMIZED CONTROLLED-TRIAL
KW - EARLY-PREGNANCY FAILURE
KW - 1ST-TRIMESTER MISCARRIAGE
KW - SPONTANEOUS-ABORTION
KW - MEDICAL-MANAGEMENT
KW - ECONOMIC-EVALUATION
KW - MIST TRIAL
KW - PREFERENCES
KW - RISK
KW - SATISFACTION
U2 - 10.1016/j.ejogrb.2017.01.019
DO - 10.1016/j.ejogrb.2017.01.019
M3 - Article
SN - 0301-2115
VL - 211
SP - 83
EP - 89
JO - European journal of obstetrics gynecology and reproductive biology
JF - European journal of obstetrics gynecology and reproductive biology
ER -