Providing Mifepristone and Misoprostol in Emergency Departments During the COVID-19 Pandemic
Obstetrics and Gynecology
; 139(SUPPL 1):3S, 2022.
Article
in English
| EMBASE | ID: covidwho-1925135
ABSTRACT
INTRODUCTION:
Compared to misoprostol alone, medical management of early pregnancy loss (EPL) with mifepristone and misoprostol has a 25% higher success rate, reduces subsequent uterine aspiration, and is cost-effective. During the COVID-19 pandemic, we began providing mifepristone and misoprostol for EPL in our urban emergency departments (EDs), aiming to increase access to essential services and to minimize repeated health care visits. We sought to describe the safety and efficacy of this novel practice.METHODS:
With institutional review board approval, we retrospectively reviewed the charts of all patients receiving mifepristone and misoprostol for first trimester pregnancy management in our EDs between April 2020 and March 2021 (n=33). Effective treatment was defined as pregnancy resolution after a single treatment with mifepristone and misoprostol. Safety outcomes included need for additional management, emergent surgical interventions, and blood transfusion. Descriptive statistics and univariate analysis were performed.RESULTS:
The prevalence of effective treatment was 70% (n=23). Among the 10 subjects (30%) requiring additional management, interventions were one additional dose of misoprostol (n=4), uterine aspiration (n=4), methotrexate (n=1), and uterine artery embolization (n=1). Three interventions (30%) were emergent, and two of these patients also required transfusion. Demographic characteristics were not associated with effective treatment nor with safety outcomes. Twenty-eight subjects (84%) participated in follow-up, 17 via telemedicine and 11 in person.CONCLUSION:
Providing mifepristone and misoprostol for EPL in the ED may be an effective method to increase health care access. Further research is needed to determine whether this population is truly at increased risk for serious complications.
methotrexate; mifepristone; misoprostol; adult; aspiration; blood transfusion; clinical article; complication; conference abstract; controlled study; coronavirus disease 2019; demographics; drug safety; emergency ward; female; first trimester pregnancy; follow up; health care access; human; institutional review; outcome assessment; pandemic; pregnancy; prevalence; retrospective study; telemedicine; univariate analysis; uterine artery embolization
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Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Obstetrics and Gynecology
Year:
2022
Document Type:
Article
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