Treatment of miscarriage in first trimester with Misoprostol effective with few side effects: Study
Researchers have defined that first-trimester medical treatment of early miscarriage with Misoprostol has a high success rate and few side effects. Recently, one such study was published in Archives of Gynecology and Obstetrics by Meister L. and colleagues.
In this retrospective study carried out at the Otto von Guericke University Women's Hospital, predictive parameters for successful Misoprostol therapy were investigated. This study was aimed at assessing if various clinical factors, including endometrial stripe thickness, could indicate the need for further intervention in the form of curettage. The conclusion reached was that evaluation of endometrial stripe thickness after a patient has completed the second cycle of Misoprostol may turn out to be a good marker for treatment success.
Miscarriage in the first trimester is a common problem in clinical practice, which is mainly managed medicinally. Misoprostol is one of the most commonly used prostaglandin E1 analogues for this condition due to its effectiveness and safety profile. However, the dosage regimen has not been standardized yet, and it is unknown whether previous pregnancies, deliveries, or their modes have an effect on the outcome. A better understanding of parameters that might predict the success or failure of such treatment would potentially improve treatment protocols for these women.
This was a retrospective study done at the Otto von Guericke University Women's Hospital from 2018 to 2021, whereby the records of women who had an early miscarriage and had been treated using Misoprostol were reviewed.For the purpose of this study, the need for curettage following treatment was taken to be an indicator of failure of the treatment. Double endometrial stripe thickness measured by TVUS after the second cycle of Misoprostol was evaluated for its predictive value in this study.
All statistical analyses were done using the Statistical Package for the Social Sciences, Version 28.0. All tests were two-sided, with the level of significance set at p < 0.050.
Key Findings
In this study, 86% (n = 114) of women treated for medication abortion with Misoprostol succeeded in therapy and did not need curettage. Only 14% (n = 20) of the patients needed additional surgical intervention.
Mild side effects were observed in 16% of participants; nausea was the most common, affecting 9.2% of the study population. This confirms the safety and tolerability of misoprostol for the management of early miscarriage.
This study demonstrated that there was a significant association between endometrial stripe thickness after the second Misoprostol cycle and the need for curettage: p = 0.035. Using Receiver Operating Characteristic analysis, a cutoff value of 8.8 mm with thicker measurements was determined for a higher likelihood of treatment failure.
This would allow clinicians to use the thickness of the endometrial stripe as a predictor of outcome following treatment, so intervention in a timely fashion would obviate the need for unnecessary procedures.
The findings of the study provide supporting evidence for the usage of misoprostol in treating early miscarriage, with a success rate of 86%. Data also indicate the usefulness of endometrial stripe thickness measurement as a possible marker for prognosis in regard to the outcome of the treatment. Patients with thicker endometrial stripes after two cycles of misoprostol may benefit from closer monitoring and early consideration for other treatments like curettage.
This study shows that the measurement of endometrial stripe thickness by transvaginal ultrasound after the second cycle of misoprostol can be used as a predictive marker of successful treatment of miscarriage. Data will also show that such an approach may guide clinical decision-making and potentially decrease additional surgical procedures. Although the effectiveness of Misoprostol in the treatment of early miscarriage was 86%, with a low rate of complications, this drug still remains effective and safe; however, individualized treatment according to endometrial thickness might bring even better outcomes.
Reference:
Meister, L., Künnemann, I., Fettke, F., Lux, A., & Ignatov, A. (2024). Medical treatment of miscarriage using misoprostol—a retrospective study. Archives of Gynecology and Obstetrics. https://doi.org/10.1007/s00404-024-07628-6
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