Surgical intervention after medical treatment for early pregnancy loss according to gestational size. Issue 3 (16th August 2022)

• Record Type: Journal Article
• Authors: Gluck, Ohad; Barber, Elad; Tal, Ori; Kerner, Ram; Weiner, Eran; Sagiv, Ron
• Is Part Of: International journal of gynaecology and obstetrics. Volume 160:Issue 3(2023)
• Page Start: 933
• Page End: 938
• Publication Date: 2022-08-16
• Subjects: early pregnancy loss -- gestational size -- misoprostol -- ultrasound; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1002/ijgo.14371
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: Objective: To study the rate of surgical intervention for unsuccessful medical treatment in early pregnancy loss (EPL), according to gestational size by ultrasound (GS‐US). Methods: This was a retrospective cohort study. All women who were treated with misoprostol for EPL between July 2015 and December 2020 were included. The cohort was divided according to GS‐US: group 1: gestational sac without an embryonic pole; group 2: an embryonic pole with crown‐rump length (CRL) compatible with <7 weeks; group 3: CRL compatible with 7 +0 –7 +6 weeks; group 4: CRL compatible with 8 +0 –8 +6 weeks; group 5: CRL compatible with ≥9 weeks. We compared the rate of any surgical intervention due to treatment failure. Results: Overall, 783 patients were included: group 1, 236 (30.1%); group 2, 319 (40.7%); group 3, 115 (14.7%); group 4, 78 (10.0%); and group 5, 35 (5.0%) patients. The rate of any surgical intervention was significantly lower in groups 1–4 (54, 22.9%; 85, 26.6%; 28, 24.3%; and 22, 28.2%, respectively) compared with group 5 (17, 48.6%; P = 0.030). On multivariant analysis, GS‐US greater than 9 weeks was independently associated with the need for surgical intervention (adjusted odds ratio 1.23, 95% confidence interval 1.01–1.51; P = 0.040). Conclusion: When treating EPL medically, GS‐US greater than 9 weeks increases the risk of undergoing additional surgical intervention compared with younger weeks. Synopsis: When treating missed abortions medically, gestational size of 9 weeks or more increases the risk of undergoing additional surgical intervention compared with younger weeks.