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

作者：Lemmers Marilee^*; Verschoor Marianne A C; Rengerink Katrien Oude; Naaktgeboren Christiana; Bossuyt Patrick M; Huirne Judith A F; Janssen Ineke A H; Radder Celine; Klinkert Ellen R; Langenveld Josje; van der Voet Lucet; Siemens E Frederike; Bongers Marlies Y; van Hooff Marcel H; van der Ploeg Marinus; Sjors F P J; Coppus S F P J; Ankum W M; Mol Ben Willem J

来源：European Journal of Obstetrics & Gynecology and Reproductive Biology, 2017, 211: 83-89.

DOI：10.1016/j.ejogrb.2017.01.019

• Misoprostol
• Curettage
• Miscarriage
• Incomplete evacuation

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.

• 出版日期2017-4