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

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

doi:10.1016/j.ejogrb.2017.01.019

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

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

Julius Center, dept. Epidemiology & Health Economics

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	83-89
Number of pages	7
Journal	European Journal of Obstetrics, Gynecology and Reproductive Biology
Volume	211
DOIs	https://doi.org/10.1016/j.ejogrb.2017.01.019
Publication status	Published - 1 Apr 2017

Keywords

Curettage
Incomplete evacuation
Miscarriage
Misoprostol

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Lemmers, M., Verschoor, M. A. C., Oude Rengerink, K., Naaktgeboren, C., Bossuyt, P. M., Huirne, J. A. F., Janssen, I. A. H., Radder, C., Klinkert, E. R., Langenveld, J., van der Voet, L., Siemens, F. F., Bongers, M. Y., van Hooff, M. H., van der Ploeg, M., Sjors, F. P. J., Coppus, S. F. P. J., Ankum, W. M., Mol, B. W. J. (2017). MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study. European Journal of Obstetrics, Gynecology and Reproductive Biology, 211, 83-89. https://doi.org/10.1016/j.ejogrb.2017.01.019

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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",

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.",

keywords = "Curettage, Incomplete evacuation, Miscarriage, Misoprostol",

author = "Marike Lemmers and Verschoor, {Marianne A C} and {Oude Rengerink}, Katrien and Christiana Naaktgeboren and Bossuyt, {Patrick M} and Huirne, {Judith A F} and Janssen, {Ineke A H} and Celine Radder and Klinkert, {Ellen R} and Josje Langenveld and {van der Voet}, Lucet and Siemens, {F Frederike} and Bongers, {Marlies Y} and {van Hooff}, {Marcel H} and {van der Ploeg}, Marinus and Sjors, {F P J} and Coppus, {S F P J} and Ankum, {W M} and Mol, {Ben Willem J}",

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doi = "10.1016/j.ejogrb.2017.01.019",

language = "English",

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Lemmers, M, Verschoor, MAC, Oude Rengerink, K, Naaktgeboren, C, Bossuyt, PM, Huirne, JAF, Janssen, IAH, Radder, C, Klinkert, ER, Langenveld, J, van der Voet, L, Siemens, FF, Bongers, MY, van Hooff, MH, van der Ploeg, M, Sjors, FPJ, Coppus, SFPJ, Ankum, WM, Mol, BWJ 2017, 'MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study', European Journal of Obstetrics, Gynecology and Reproductive Biology, vol. 211, pp. 83-89. https://doi.org/10.1016/j.ejogrb.2017.01.019

MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study. / Lemmers, Marike; Verschoor, Marianne A C; Oude Rengerink, Katrien et al.
In: European Journal of Obstetrics, Gynecology and Reproductive Biology, Vol. 211, 01.04.2017, p. 83-89.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - MisoREST

T2 - Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study

AU - Lemmers, Marike

AU - Verschoor, Marianne A C

AU - Oude Rengerink, Katrien

AU - Naaktgeboren, Christiana

AU - Bossuyt, Patrick M

AU - Huirne, Judith A F

AU - Janssen, Ineke A H

AU - Radder, Celine

AU - Klinkert, Ellen R

AU - Langenveld, Josje

AU - van der Voet, Lucet

AU - Siemens, F Frederike

AU - Bongers, Marlies Y

AU - van Hooff, Marcel H

AU - van der Ploeg, Marinus

AU - Sjors, F P J

AU - Coppus, S F P J

AU - Ankum, W M

AU - Mol, Ben Willem J

PY - 2017/4/1

Y1 - 2017/4/1

N2 - 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.

AB - 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.

KW - Curettage

KW - Incomplete evacuation

KW - Miscarriage

KW - Misoprostol

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U2 - 10.1016/j.ejogrb.2017.01.019

DO - 10.1016/j.ejogrb.2017.01.019

M3 - Article

C2 - 28209537

SN - 0301-2115

VL - 211

SP - 83

EP - 89

JO - European Journal of Obstetrics, Gynecology and Reproductive Biology

JF - European Journal of Obstetrics, Gynecology and Reproductive Biology

ER -

Lemmers M, Verschoor MAC, Oude Rengerink K, Naaktgeboren C, Bossuyt PM, Huirne JAF et al. MisoREST: Surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: A cohort study. European Journal of Obstetrics, Gynecology and Reproductive Biology. 2017 Apr 1;211:83-89. doi: 10.1016/j.ejogrb.2017.01.019

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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Keywords

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