Background
Despite the rise of medical treatments for the termination of pregnancy, to date,
no prospective trial has evaluated the efficacy of misoprostol in treating retained
products of conception after induced termination of pregnancy.
Objective
This study aimed to compare medical management with misoprostol with expectant management
for retained products of conception after first-trimester medical termination of pregnancy.
Study Design
This was an open-label randomized controlled trial conducted at a university-affiliated
tertiary medical center. Consenting consecutive women who underwent a routine 3-week
follow-up evaluation after medical termination of pregnancy and had a sonographic
suspicion of retained products of conception, defined as sonographic evidence of intrauterine
remnant (>12 mm) with a positive Doppler flow, were recruited. The participants were
randomized into a medical treatment group (800 μg of sublingually administered misoprostol)
or expectant management. They all underwent repeat ultrasound scans every 2 weeks
until a maximum of 6 weeks, and those suspected of persistent retained products of
conception were referred to operative hysteroscopy. The primary endpoint was successful
treatment defined as no need for surgical intervention because of persistent retained
products of conception within 8 weeks from pregnancy termination.
Results
There was no marked difference in demographic characteristics between the study groups.
The median sonographically demonstrated retained product length was 20 mm (interquartile
range, 17–25) in the medically managed group compared with 20 mm (interquartile range,
17–26) in the expectantly managed group (P=.733). Treatment succeeded in 42 of 68 women (61.8%) in the medically managed group
compared with 36 of 63 women (57.1%) in the expectantly managed group (relative risk,
1.12; 95% confidence interval, 0.74–1.70; P=.590). There was no difference in adverse outcomes between the 2 groups.
Conclusion
There was no clinically meaningful advantage for medical treatment with misoprostol
compared with expectant management after first-trimester medical termination of pregnancy
in women with suspected retained products of conception. Surgical intervention can
be avoided in up to 60% of women who are managed expectantly for 8 weeks of follow-up.
Key words
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Article info
Publication history
Published online: June 22, 2022
Accepted:
June 16,
2022
Received in revised form:
May 5,
2022
Received:
December 26,
2021
Footnotes
The authors report no conflict of interest.
This study received no funding.
This study was registered on ClinicalTrials.gov (registration number: NCT04685694; www.clinicaltrials.gov). Date of trial registration was on October 1, 2020.
Cite this article as: Tzur Y, Berkovitz Shperling R, Goitein Inbar T, et al. Expectant vs medical management for retained products of conception after medical termination of pregnancy: a randomized controlled study. Am J Obstet Gynecol 2022;227:599.e1-9.
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