MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study

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Title:	MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study
Author(s):	Lemmers, M.; Verschoor, M.A.; Oude Rengerink, K.; Naaktgeboren, C.; Bossuyt, P.M.; Huirne, J.A.; Janssen, I.A.W.; Radder, C.; Klinkert, E.R.; Langenveld, J.; Voet, L. Van der; Siemens, F.F.; Bongers, M.Y.; Hooff, M.H. van; Ploeg, M.; Coppus, S.F.P.J.; Ankum, W.M.; Mol, B.W.
Publication year:	2017
Source:	European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 211, (2017), pp. 83-89
ISSN:	0301-2115
DOI:	https://doi.org/10.1016/j.ejogrb.2017.01.019
Publication type:	Article / Letter to editor
Please use this identifier to cite or link to this item : http://hdl.handle.net/2066/174776
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Subject:	Radboudumc 17: Women's cancers RIHS: Radboud Institute for Health Sciences
Organization:	Gynaecology
Journal title:	European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume:	vol. 211
Page start:	p. 83
Page end:	p. 89
Abstract:	OBJECTIVE: To assess the effectiveness of curettage versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. STUDY DESIGN: We conducted a multicenter cohort study alongside a randomized clinical trial (RCT) between June 2012 until July 2014. 27 Dutch hospitals participated. Women with an incomplete evacuation after misoprostol treatment for first trimester miscarriage who declined to participate in the RCT, received treatment of their preference; curettage (n=65) or expectant management (n=132). A successful outcome was defined as an empty uterus on sonography at six weeks or uneventful clinical follow-up. We furthermore assessed complication rate and (re)intervention rate RESULTS: Of the 197 women who declined to participate in the RCT, 65 preferred curettage and 132 expectant management. A successful outcome was observed in 62/65 women (95%) in the surgical group versus 112/132 women (85%) in the expectant group (RR 1.1, 95% CI 1.03-1.2), with complication rates of 6.2% versus 2.3%, respectively (RR 2.7, 95% CI 0.6-12). CONCLUSION: In women with an incomplete evacuation of the uterus after misoprostol treatment, expectant management is an effective and safe option. This finding could restrain the use of curettage in women that have used misoprostol in the treatment of first trimester miscarriage.