Misoprostol no better than expectant care after MTP with suspected retained products of conception

A new study conducted by Yossi Tzur and team showed that after a first-trimester medical termination of pregnancy in women with probable retained products of conception, there was no clinically significant benefit to misoprostol therapy compared to expectant care.

The findings of this study were published in the American Journal of Obstetrics & Gynecology.

To date, no prospective study has assessed the effectiveness of misoprostol in treating retained products of conception following an induced termination of pregnancy, despite the growth of medical procedures for ending pregnancies. In order to compare medical care with misoprostol with expectant management for retained sperm and eggs following first-trimester medical termination of pregnancy, researchers performed this study.

An open-label randomized controlled study was carried out in a tertiary medical facility that was connected with a university. Consenting women who had a sonographic suspicion of retained fetal products of conception—defined as sonographic evidence of intrauterine remnant (>12 mm) with a positive Doppler flow—and attended a standard 3-week follow-up examination following medical termination of pregnancy were recruited. Participants were randomly assigned to receive medical therapy or expectant care. They all had follow-up ultrasound exams every two weeks until a maximum of six weeks, and those who were thought to have persistently retained fetuses were advised to have an operation hysteroscopy. The main goal of the therapy was to avoid the necessity for surgery due to persistent retained fetal products within eight weeks following the pregnancy's termination.

The key findings of this study were:

1. The research groups' demographic features did not significantly differ from one another.

2. In comparison to the expectantly managed group, the medically managed group had a median retained product length of 20 mm (interquartile range, 17–25) as opposed to the expectantly managed group's 20 mm (interquartile range, 17–26) (P=.733).

3. Compared to 36 of 63 women (57.1%) in the expectantly managed group, 42 of 68 women (61.8%) in the medically managed group experienced success with treatment.

4. The two groups had the same negative results.

Reference:

Tzur, Y., Berkovitz-Shperling, R., Goitein Inbar, T., Bar-On, S., Gil, Y., Levin, I., & Cohen, A. (2022). Expectant vs medical management for retained products of conception after medical termination of pregnancy: a randomized controlled study. In American Journal of Obstetrics and Gynecology (Vol. 227, Issue 4, p. 599.e1-599.e9). Elsevier BV. https://doi.org/10.1016/j.ajog.2022.06.025