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The medical management of missed miscarriage: outcomes from a prospective, single-centre, Australian cohort

Scott G Petersen, Anneliese R Perkins, Kristen S Gibbons, Julia I Bertolone and Kassam Mahomed
Med J Aust 2013; 199 (5): 341-346. || doi: 10.5694/mja12.11813

Summary

Objective: To report the prospective outcomes of medical management of missed miscarriage before 13 weeks' gestation from an Australian cohort.

Design: Descriptive study of a cohort selected out of a randomised controlled trial.

Setting: Outpatient management at a maternity hospital between 1 May 2007 and 28 July 2010.

Participants: 264 women requesting medical management of missed miscarriage.

Main outcome measures: Number of doses of misoprostol required, unscheduled visits for care, findings at ultrasound follow-up, requirement for surgical management, number of cases of gestational trophoblastic disease (GTD), and self-reported patient experience.

Results: 107 women (40.5%) received a repeat dose of misoprostol, and 79 women (29.9%) made unscheduled visits for care. Among the 241 women with Day 7 ultrasound follow-up, a gestational sac was found in 32 women (13.3%), indicating failure of medical management. Complete miscarriage was induced without the need for surgery in 206 women (78.0%). Surgery was performed as an emergency in 13 women (4.9%). Twelve women (4.5%) had surgery for ongoing bleeding after medical management, and four of these did not have chorionic villi on histopathological examination. Five women (1.9%) had GTD, which was managed incidentally under the protocol. Among those who returned patient questionnaires, 73.0% participants (116/159) indicated that they would recommend medical management of miscarriage to other women, while 18.2% (29/159) indicated that they would undergo surgery next time.

Conclusion: The medical management of missed miscarriage on an outpatient basis is safe and effective.

Trial registration: ACTRN12612000150842.

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  • Scott G Petersen1
  • Anneliese R Perkins1
  • Kristen S Gibbons2
  • Julia I Bertolone1
  • Kassam Mahomed2,3

  • 1 Mater Mothers’ Hospital, Brisbane, QLD.
  • 2 Mater Medical Research Institute, Brisbane, QLD.
  • 3 Ipswich Hospital, Brisbane, QLD.


Acknowledgements: 

We are grateful to all the registrars, consultants and nursing staff who assisted with recruitment into the study and management of the participating women at the Mater Mothers' Hospital. We acknowledge the Mater Research Support Centre for their support and encouragement.

Competing interests:

No relevant disclosures.

  • 1. 17th Expert Committee on the Selection of Use of Essential Medicines. Proposal for the inclusion of misoprostol in the WHO model list of essential medicines. Geneva, March 2009. http://www.who.int/selection_medicines/committees/expert/17/application/Miso_Incl_2.pdf (accessed Jul 2010).
  • 2. Royal Australian and of Obstetricians and Gynaecologists. The use of misoprostol in obstetrics. College statement C-Obs 12. November 2001. http://www.ranzcog.edu.au/partially-comparable/assessment-workshops-forms/logbook-a-tar/doc_download/946-c-obs-12-the-use-of-misoprostol-in-obstetrics.html (accessed Apr 2007).
  • 3. Zhang J, Gilles JM, Barnhart K, et al. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med 2005; 353: 761-769.
  • 4. Trinder J, Brocklehurst P, Porter R, et al. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). BMJ 2006; 332: 1235-1240.
  • 5. Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis J. Expectant, medical, or surgical management of first trimester miscarriage: a meta-analysis. Obstet Gynecol 2005; 105: 1104-1113.
  • 6. Neilson JP, Hickey M, Vazquez J. Medical treatment for early fetal death (less than 24 weeks). Cochrane Database Syst Rev 2006; (3): CD002253.
  • 7. Wood SL, Brain PH. Medical management of missed abortion: a randomized clinical trial. Obstet Gynecol 2002; 99: 563-566.
  • 8. Heard MJ, Stewart GM, Buster JE, et al. Outpatient management of missed abortion with vaginal misoprostol. Obstet Gynecol 2002; 99 Suppl 4: 20S-21S.
  • 9. Shelley JM, Healy D, Grover S. A randomised trial of surgical, medical and expectant management of first trimester spontaneous miscarriage. Aust N Z J Obstet Gynaecol 2005; 45: 122-127.
  • 10. McLaren B, Shelley JM. Reported management of early-pregnancy bleeding and miscarriage by general practitioners in . Med J Aust 2002; 176: 63-66. <MJA full text>
  • 11. Petersen SG, Perkins A, Gibbons K, et al. Can we use a lower intravaginal dose of misoprostol in the medical management of miscarriage? A randomised controlled study. Aust N Z J Obstet Gynaecol 2013; 53: 64-73.
  • 12. Barceló F, De Paco C, López-Espín JJ, et al. The management of missed miscarriage in an outpatient setting: 800 versus 600 μg of vaginal misoprostol. Aust N Z J Obstet Gynaecol 2012; 52: 39-43.
  • 13. Torre A, Huchon C, Bussieres L, et al. Immediate versus delayed medical treatment for first-trimester miscarriage: a randomized trial. Am J Obstet Gynecol 2012; 206: 215.e1-215.e6.
  • 14. Creinin MD, Huang X, Westhoff C, et al. Factors related to successful misoprostol treatment for early pregnancy failure. Obstet Gynecol 2006; 107: 901-907.
  • 15. Chen BA, Reeves MF, Creinin MD, et al. Misoprostol for treatment of early pregnancy failure in women with previous uterine surgery. Am J Obstet Gynecol 2008; 198: 626.e1-626.e5.
  • 16. Johnson N, Priestnall M, Marsay T, et al. A randomised trial evaluating pain and bleeding after a first trimester miscarriage treated surgically or medically. Eur J Obstet Gynecol Reprod Biol 1997; 72: 213-215.
  • 17. Nielsen S, Hahlin M, Möller A, Granberg S. Bereavement, grieving and psychological morbidity after first trimester spontaneous abortion: comparing expectant management with surgical evacuation. Hum Reprod 1996; 11: 1767-1770.
  • 18. Blohm F, Hahlin M, Nielsen S, Milsom I. Fertility after a randomised trial of spontaneous abortion managed by surgical evacuation or expectant treatment. Lancet 1997; 349: 995.
  • 19. Graziosi GC, Bruinse HW, Reuwer PJ, Mol BW. Women's preferences for misoprostol in case of early pregnancy failure. Eur J Obstet Gynecol Reprod Biol 2006; 124: 184-186.
  • 20. Reeves MF, Lohr PA, Harwood BJ, Creinin MD. Ultrasonographic endometrial thickness after medical and surgical management of early pregnancy failure. Obstet Gynecol 2008; 111: 106-112.
  • 21. Heath V, Chadwick V, Cooke I, et al. Should tissue from pregnancy termination and uterine evacuation routinely be examined histologically? BJOG 2000; 107: 727-730.
  • 22. Sebire NJ, Rees H, Paradinas F, et al. The diagnostic implications of routine ultrasound examination in histologically confirmed early molar pregnancies. Ultrasound Obstet Gynecol 2001; 18: 662-665.
  • 23. Kirk E, Papageorghiou AT, Condous G, et al. The accuracy of first trimester ultrasound in the diagnosis of hydatidiform mole. Ultrasound Obstet Gynecol 2007; 29: 70-75.
  • 24. Tasci Y, Dilbaz S, Secilmis O, et al. Routine histopathologic analysis of product of conception following first-trimester spontaneous miscarriages. J Obstet Gynaecol Res 2005; 31: 579-582.
  • 25. Sebire NJ. Hydatidiform mole and medical management of miscarriage. BMJ 2006; 332: 1454.

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