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 journalArticle

14 Citations (Scopus)

Abstract

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
JournalContraception
Volume78
Issue number4
DOIs
StatePublished - Oct 2008
Externally publishedYes

Fingerprint

Gestational Sac
Misoprostol
Pregnancy
Mifepristone
Telephone
Pregnant Women
Ultrasonography
Therapeutics

Keywords

  • Gestational sac
  • Medical abortion
  • Mifepristone
  • Misoprostol

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Medical abortion outcomes after a second dose of misoprostol for persistent gestational sac. / Reeves, Matthew F.; Kudva, Anupa; Creinin, Mitchell D.

In: Contraception, Vol. 78, No. 4, 10.2008, p. 332-335.

Research output: Contribution to journalArticle

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abstract = "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.",
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