Tags

Type your tag names separated by a space and hit enter

Fertility and obstetric outcomes after curettage versus expectant management in randomised and non-randomised women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage.
Eur J Obstet Gynecol Reprod Biol. 2017 Apr; 211:78-82.EJ

Abstract

OBJECTIVE

To assess fertility and obstetric outcomes in women treated with curettage or undergoing expectant management for an incomplete miscarriage after misoprostol treatment.

STUDY DESIGN

Between June 2012 and July 2014, we conducted a multicentre randomised clinical trial (RCT) with a parallel cohort study for non-randomised women, treated according to their preference. In the RCT 30 women were allocated curettage and 29 expectant management. In the cohort 197 women participated; 65 underwent curettage and 132 women underwent expectant management. Primary outcome was curation, defined as either an empty uterus on sonography at six weeks or an uneventful clinical follow-up. We used questionnaires to assess fertility and obstetric outcome of the first new pregnancy subsequent to study enrolment.

RESULTS

Curation was seen in 91/95 women treated with curettage (95.8%) versus 134/161 women managed expectantly (83.2%) (p=0.003). The response rate was 211/255 (82%). In 198 women pursuing a new pregnancy, conception rates were 92% (67/73) in the curettage group versus 96% (120/125) in the expectant management group (OR 0.96, 95% CI 0.89;1.03, p=0.34), with ongoing pregnancy rates of 87% (58/67) versus 78% (94/120), respectively (OR 1.12, 95% CI 0.99;1.28, p=0.226). Preterm birth rates were 1/46 in the curettage group versus 8/81 in the expectant management group (OR 0.22, 95% CI 0.03;1.71 P=0.15). Caesarean section rates were 23% and 24% for women in the curettage group and expectant management group respectively.

CONCLUSION

In women with an incomplete evacuation of the uterus after misoprostol treatment, curettage and expectant management does not lead to different fertility and pregnancy outcomes, as compared to expectant management.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, VU Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: marike.lemmers@gmail.com.Department of Obstetrics and Gynaecology, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands.Department of Obstetrics and Gynaecology, VU Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.Clinical Research Unit, University of Amsterdam, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands.Department of Obstetrics and Gynaecology, Amphia Ziekenhuis, P.O. Box 90158, 4800 RK, Breda, The Netherlands.Department of Obstetrics and Gynaecology, Westfriesgasthuis, P.O. Box 600, 1620AR, Hoorn, The Netherlands.Department of Obstetrics and Gynaecology, Isala Kliniek, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands.Department of Obstetrics and Gynaecology, Noordwest Ziekenhuisgroep, P.O. Box 501, 1800 AM, Alkmaar, The Netherlands.Department of Obstetrics and Gynaecology, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands.Department of Obstetrics and Gynaecology, VU Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.The Robinson Research Institute|School of Medicine, University of Adelaide, The South Australian Health and Medical Research Institute, Adelaide, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28199872

Citation

Lemmers, M, et al. "Fertility and Obstetric Outcomes After Curettage Versus Expectant Management in Randomised and Non-randomised Women With an Incomplete Evacuation of the Uterus After Misoprostol Treatment for Miscarriage." European Journal of Obstetrics, Gynecology, and Reproductive Biology, vol. 211, 2017, pp. 78-82.
Lemmers M, Verschoor MAC, Overwater K, et al. Fertility and obstetric outcomes after curettage versus expectant management in randomised and non-randomised women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage. Eur J Obstet Gynecol Reprod Biol. 2017;211:78-82.
Lemmers, M., Verschoor, M. A. C., Overwater, K., Bossuyt, P. M., Hendriks, D., Hemelaar, M., Schutte, J. M., Adriaanse, A. H., Ankum, W. M., Huirne, J. A. F., & Mol, B. W. J. (2017). Fertility and obstetric outcomes after curettage versus expectant management in randomised and non-randomised women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 211, 78-82. https://doi.org/10.1016/j.ejogrb.2017.01.055
Lemmers M, et al. Fertility and Obstetric Outcomes After Curettage Versus Expectant Management in Randomised and Non-randomised Women With an Incomplete Evacuation of the Uterus After Misoprostol Treatment for Miscarriage. Eur J Obstet Gynecol Reprod Biol. 2017;211:78-82. PubMed PMID: 28199872.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fertility and obstetric outcomes after curettage versus expectant management in randomised and non-randomised women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage. AU - Lemmers,M, AU - Verschoor,M A C, AU - Overwater,K, AU - Bossuyt,P M, AU - Hendriks,D, AU - Hemelaar,M, AU - Schutte,J M, AU - Adriaanse,A H, AU - Ankum,W M, AU - Huirne,J A F, AU - Mol,B W J, Y1 - 2017/01/30/ PY - 2016/12/15/received PY - 2017/01/24/accepted PY - 2017/2/16/pubmed PY - 2017/9/28/medline PY - 2017/2/16/entrez KW - Curettage KW - Fertility KW - Incomplete evacuation KW - Miscarriage KW - Misoprostol KW - Obstetric outcome SP - 78 EP - 82 JF - European journal of obstetrics, gynecology, and reproductive biology JO - Eur J Obstet Gynecol Reprod Biol VL - 211 N2 - OBJECTIVE: To assess fertility and obstetric outcomes in women treated with curettage or undergoing expectant management for an incomplete miscarriage after misoprostol treatment. STUDY DESIGN: Between June 2012 and July 2014, we conducted a multicentre randomised clinical trial (RCT) with a parallel cohort study for non-randomised women, treated according to their preference. In the RCT 30 women were allocated curettage and 29 expectant management. In the cohort 197 women participated; 65 underwent curettage and 132 women underwent expectant management. Primary outcome was curation, defined as either an empty uterus on sonography at six weeks or an uneventful clinical follow-up. We used questionnaires to assess fertility and obstetric outcome of the first new pregnancy subsequent to study enrolment. RESULTS: Curation was seen in 91/95 women treated with curettage (95.8%) versus 134/161 women managed expectantly (83.2%) (p=0.003). The response rate was 211/255 (82%). In 198 women pursuing a new pregnancy, conception rates were 92% (67/73) in the curettage group versus 96% (120/125) in the expectant management group (OR 0.96, 95% CI 0.89;1.03, p=0.34), with ongoing pregnancy rates of 87% (58/67) versus 78% (94/120), respectively (OR 1.12, 95% CI 0.99;1.28, p=0.226). Preterm birth rates were 1/46 in the curettage group versus 8/81 in the expectant management group (OR 0.22, 95% CI 0.03;1.71 P=0.15). Caesarean section rates were 23% and 24% for women in the curettage group and expectant management group respectively. CONCLUSION: In women with an incomplete evacuation of the uterus after misoprostol treatment, curettage and expectant management does not lead to different fertility and pregnancy outcomes, as compared to expectant management. SN - 1872-7654 UR - https://www.unboundmedicine.com/medline/citation/28199872/Fertility_and_obstetric_outcomes_after_curettage_versus_expectant_management_in_randomised_and_non_randomised_women_with_an_incomplete_evacuation_of_the_uterus_after_misoprostol_treatment_for_miscarriage_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0301-2115(17)30067-2 DB - PRIME DP - Unbound Medicine ER -