Medical abortion outcomes after a second dose of misoprostol for persistent gestational sac

Matthew F. Reeves, Anupa Kudva, Mitchell D Creinin

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: We sought to examine outcomes after a second dose of misoprostol was given at a 1-week follow-up visit after medical abortion for the presence of a persistent gestational sac (GS) on ultrasound examination. Study Design: We examined outcomes in women who were enrolled in two randomized trials of medical abortion regimens. Pregnant women up to 63 days' gestation received mifepristone followed by misoprostol 800 mcg vaginally either 24 h later, 6-8 h later or within 15 min. Participants in both studies returned for an evaluation, including transvaginal ultrasonography, approximately 7 days after initiating treatment. We included women with a GS present at the follow-up visit. Subjects who had not expelled the GS received a second dose of misoprostol 800 mcg vaginally. Participants returned approximately 1 week later and were contacted by telephone 5 weeks after treatment. Results: Of 1972 women who had a follow-up ultrasound examination within 11 days of treatment, a persistent GS was identified in 82 women (4.2%) of whom 68 opted to receive a second dose of misoprostol. All 68 women returned for follow-up evaluation and 42 (62%) expelled the GS. In the 26 women with an embryonic pole within the persistent sac, expulsion occurred in 5 (36%) of 14 with and 7 (54%) of 13 without gestational cardiac activity (GCA) (p=.45). Of the 14 pregnancies with GCA, only 5 (36%) had GCA at follow-up. Conclusions: More than half of women with a persistent GS after medical abortion will expel the pregnancy when treated with a second dose of misoprostol. One-third of women who have a GS with cardiac activity will expel the GS with a second dose of misoprostol, making a second dose a reasonable option.

Original languageEnglish (US)
Pages (from-to)332-335
Number of pages4
Issue number4
StatePublished - Oct 2008
Externally publishedYes


  • Gestational sac
  • Medical abortion
  • Mifepristone
  • Misoprostol

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology


Dive into the research topics of 'Medical abortion outcomes after a second dose of misoprostol for persistent gestational sac'. Together they form a unique fingerprint.

Cite this