Outcomes of incomplete abortion related to treatment modality

• Published in: Archives of gynecology and obstetrics Vol. 308; no. 5; pp. 1543 - 1548
• Main Authors: Sharvit, Merav, Yagur, Yael, Shams, Rebecca, Daykan, Yair, Klein, Zvi, Schonman, Ron
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2023; Springer Nature B.V
• Subjects: Endocrinology; General Gynecology; Gynecology; Human Genetics; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Pharmaceuticals; Incomplete abortion; Hysteroscopy; Misoprostol; Retained products of conception
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-023-07182-7

Purpose
This study evaluated the differences in treatment outcomes between misoprostol and surgical evacuation for the management of incomplete abortion.
Methods
This retrospective cohort study compared patients with a clinical diagnosis of incomplete abortion who underwent surgical or pharmaceutical (misoprostol) intervention, 2014–2017. Demographics, sonographic results, treatment follow-up, and post-intervention data on retained products of conception were retrieved. Women with incomplete abortion who underwent surgical versus pharmaceutical intervention were compared.
Results
Among 589 spontaneous abortions, 198 were included in the study, of which 123 (62.1%) underwent surgical evacuation and 75 (37.9%) pharmaceutical intervention with misoprostol. Baseline characteristics were similar between groups. During 130.8 ± 91.7 days of follow-up, no patient who underwent surgical evacuation had retained products of conception or needed surgical hysteroscopy. Four cases (5.3%) in the misoprostol group had retained products of conception and needed hysteroscopy (p = 0.02). Patients who underwent surgical evacuation had higher hemoglobin levels during follow-up (12.1 mg/dL vs. 11.7 mg/dL, p = 0.05). There were no differences in post-treatment pregnancy rates between groups.
Conclusion
Long-term follow-up after incomplete abortion showed that hemodynamically stable patients treated with misoprostol achieved the desired results in 95% of cases without significant differences in pregnancy intervals compared to surgical management. Further prospective studies with larger sample sizes are required to confirm the outcomes described in this study.