Effect of Uterine Cavity Measurements on Medical Management Failure in Early Pregnancy Loss [296]. (May 2015)

• Record Type: Journal Article
• Authors: Lavecchia, Melissa; Abenhaim, Haim Arie
• Is Part Of: Obstetrics and gynecology. Volume 125(2015)Supplement 1
• Publication Date: 2015-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000463197.52783.a2
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: The purpose of our study was to evaluate the predictive value of uterine content ultrasound measurements in predicting medical management failure of early pregnancy loss. METHODS: We conducted a retrospective cohort study in a single university-affiliated hospital center on all women discharged from the emergency department with a diagnosis of early pregnancy failure who were managed with misoprostol. Only women with ultrasonographic data available for review between 2011 and 2013 were included. Exposure of interest consisted of uterine cavity measurements including: anteroposterior distance, longitudinal distance, transverse distance, and uterine cavity volume. Outcome was defined as need for dilatation and curettage (D&C) or unplanned return to the emergency department. Logistic regression was used to identify ultrasonographic measurements independently associated with failed medical management. RESULTS: Among 823 women presenting to the emergency department with first-trimester bleeding, 226 met inclusion criteria. Of all measurements evaluated, anteroposterior distance was found to be independently associated with D&C and unplanned return to the emergency department. When using an anteroposterior distance cutoff of 15 mm, women were more likely to require D&C, 2.58 (1.27–5.24; P =.01) and to have an unplanned return to the emergency department, 2.63 (1.41–4.88; P =.002). In women with an anteroposterior distance below 15 mm, 87.7% had successful medical management of early pregnancy loss and 80.0% did not require an unplanned return to the emergency department. CONCLUSION: Although there is a need for further validation, using an anteroposterior distance cutoff of 15 mm in a hospital-based population of women with early pregnancy failure may be helpful in selecting patients who can safely be managed medically.