MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study

Marike Lemmers; Marianne A C Verschoor; Katrien Oude Rengerink; Christiana Naaktgeboren; Patrick M Bossuyt; Judith A F Huirne; Ineke A H Janssen; Celine Radder; Ellen R Klinkert; Josje Langenveld; Lucet van der Voet; F Frederike Siemens; Marlies Y Bongers; Marcel H van Hooff; Marinus van der Ploeg; F P J Sjors; S F P J Coppus; W M Ankum; Ben Willem J Mol; MisoREST study group

doi:10.1016/j.ejogrb.2017.01.019

MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study

Eur J Obstet Gynecol Reprod Biol. 2017 Apr:211:83-89. doi: 10.1016/j.ejogrb.2017.01.019. Epub 2017 Jan 27.

Authors

Marike Lemmers¹, Marianne A C Verschoor², Katrien Oude Rengerink³, Christiana Naaktgeboren³, Patrick M Bossuyt⁴, Judith A F Huirne⁵, Ineke A H Janssen⁶, Celine Radder⁷, Ellen R Klinkert⁸, Josje Langenveld⁹, Lucet van der Voet¹⁰, F Frederike Siemens¹¹, Marlies Y Bongers¹², Marcel H van Hooff¹³, Marinus van der Ploeg¹⁴, F P J Sjors¹⁵, S F P J Coppus¹⁵, W M Ankum², Ben Willem J Mol¹⁶; MisoREST study group

Affiliations

¹ 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.
² Department of Obstetrics and Gynaecology, Academic Medical Center, P.O. Box 22770, 1100 DE Amsterdam, The Netherlands.
³ Julius Center for Health Sciences and Primary Care, UMC Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
⁴ Clinical Research Unit, University of Amsterdam, Academic Medical Center, P.O. Box 22770, 1100 DE Amsterdam, The Netherlands.
⁵ Department of Obstetrics and Gynaecology, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
⁶ Department of Obstetrics and Gynaecology, Groene Hart Ziekenhuis, P.O. Box 1098, 2800 BB Gouda, The Netherlands.
⁷ Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis West, P.O. Box 9243, 1006 AE Amsterdam, The Netherlands.
⁸ Department of Obstetrics and Gynaecology, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
⁹ Department of Obstetrics and Gynaecology, Atrium Medical Center, P.O. Box 4446, 6401 CX Heerlen, The Netherlands.
¹⁰ Department of Obstetrics and Gynaecology, Deventer Hospital, P.O. Box 5001, 7400 GC Deventer, The Netherlands.
¹¹ Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, P.O. Box 5011, 2600 GA Delft, The Netherlands.
¹² Department of Obstetrics and Gynaecology, Maxima Medical Center, Postbus 7777, 5500 MB Veldhoven, The Netherlands.
¹³ Department of Obstetrics and Gynaecology, Sint Franciscus Gasthuis, Rotterdam, P.O. Box 10900, 3004 BA Rotterdam, The Netherlands.
¹⁴ Department of Obstetrics and Gynaecology, Martini ziekenhuis Groningen, P.O Box 30033, 9700 RM Groningen, The Netherlands.
¹⁵ Department of Obstetrics and Gynaecology,UMC St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
¹⁶ 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.

PMID: 28209537
DOI: 10.1016/j.ejogrb.2017.01.019

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.

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 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).

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.

Keywords: Curettage; Incomplete evacuation; Miscarriage; Misoprostol.

Publication types

Comparative Study

MeSH terms

Abortifacient Agents, Nonsteroidal / therapeutic use*
Abortion, Incomplete / surgery
Abortion, Incomplete / therapy*
Abortion, Spontaneous / drug therapy*
Adult
Dilatation and Curettage*
Female
Humans
Misoprostol / therapeutic use*
Pregnancy
Treatment Outcome
Watchful Waiting*

Substances

Abortifacient Agents, Nonsteroidal
Misoprostol