Conception rates after medical versus surgical evacuation of early miscarriage.

OBJECTIVE: To compare short-term fertility rates after medical and surgical management of early miscarriage. DESIGN: Observational cohort study. SETTING: Academic tertiary-care medical center. PATIENT(S): A total of 203 patients were enrolled between June 2017 and May 2018, comprising 106 surgical evacuations and 97 medical evacuations. INTERVENTION(S): Either surgical or medical evacuation of the uterine cavity. MAIN OUTCOME MEASURE(S): Conception rates 6 months after miscarriage. RESULT(S): Conception rates 6 months after miscarriage among women who had attempted to become pregnant were similar between the medically and surgically evacuated groups (68.0% vs. 65.1%). There were no significant differences in background characteristics between the groups, apart from younger age and earlier gestational age among the medically treated group. There was no difference in the proportion of women using assisted reproductive technologies between the medically and surgically managed groups (15.5% vs. 12.6%, respectively). The median time-to-conception was 4 ± 2 months in both groups. Cumulative pregnancy rate 12 months after pregnancy loss, live birth rate, and repeat miscarriage rate also were similar between groups. CONCLUSION(S): Modality of uterine evacuation after early miscarriage does not affect short-term fertility outcomes.

Advances in the management of early pregnancy loss.

PURPOSE OF REVIEW: To describe recent advances in management of early pregnancy loss. RECENT FINDINGS: Addition of mifepristone to current protocols for medical management of miscarriage increases effectiveness of a single dose of misoprostol and significantly reduces subsequent aspiration procedures. Women with an incomplete evacuation after medical management may be treated expectantly with similar rates of complete expulsion compared with surgical management at 6 weeks. As cytogenetic analysis improves, analysis of products of conception can be performed whether collected after surgical or medical management and is an efficient strategy in starting a recurrent pregnancy loss work-up. For those seeking pregnancy after miscarriage, conception immediately following an early pregnancy loss is not associated with increased risk of subsequent miscarriage. However, recent studies suggest that the original intendedness of the pregnancy resulting in miscarriage does not predict future reproductive goals of the woman, so family planning should be discussed at the time of miscarriage. SUMMARY: Miscarriage is a common experience among reproductive-aged women and advances in medical management and modern-day aspiration techniques make the use of the sharp curette obsolete.

Tratamiento médico del aborto espontáneo del primer trimestre / Medical treatment of spontaneous abortion in the first trimester

Objetivos: Evaluar la eficacia del tratamiento médico con misoprostol en el aborto espontáneo del primer trimestre de la gestación. En segundo plano, conocer la incidencia de efectos secundarios y complicaciones e identificar las causas que puedan motivar el fracaso del tratamiento médico. Establecer el grado de aceptabilidad y satisfacción de las pacientes. Realizar un estudio coste/eficacia. Sujetos y métodos: Estudio longitudinal, observacional, prospectivo, descriptivo y analítico. Se evaluó a 680 pacientes con diagnóstico de aborto espontáneo del primer trimestre en el periodo comprendido entre junio de 2009 y diciembre de 2011 en el Hospital Clínico San Carlos, elaborándose un protocolo para la administración del tratamiento médico con misoprostol para aquellas pacientes que lo aceptaban, frente al tratamiento quirúrgico clásico. Resultados: El éxito del tratamiento médico fue del 81,85%. Eficaz en el 89,21% de los abortos consumados incompletos, en el 79,52% de los abortos diferidos y en el 78,46% de las gestaciones anembrionadas. Hubo efectos secundarios menores en el 33,59% de las pacientes, declarándose satisfechas el 84,99% de las pacientes. Con respecto al estudio de costes, se produjo un ahorro por paciente de 960,54 Euros. Conclusiones: El éxito del tratamiento médico en nuestro estudio fue elevado, siendo eficaz aproximadamente en 8 de cada 10 pacientes. El misoprostol es altamente aceptado por las pacientes, declarándose la mayoría satisfechas. La incidencia de efectos secundarios menores es baja, y fueron bien tolerados, por lo que su presencia no parece que limite la aplicación de dicho tratamiento. Su utilización contribuye a reducir los costes sanitarios

Objectives: To evaluate the efficacy of medical treatment with misoprostol in spontaneous abortion in the first trimester; to determine the incidence of adverse effects and complications and identify causes that may lead to the failure of medical treatment; to identify the acceptability of the treatment, patient acceptance and patient satisfaction; and to perform a cost-effectiveness analysis. Subjects and methods: A longitudinal, observational, prospective, descriptive and analytic study was performed in 680 patients diagnosed with spontaneous abortion in the first trimester between June 2009 and December 2011 at the Hospital Clínico San Carlos. A protocol was developed for medical treatment with misoprostol administration for patients who accepted to undergo this treatment rather than classical surgery. Results: The success of medical treatment was 81.85%. The treatment was effective in 89.21% of incomplete abortions, in 79.52% of missed abortions, and in 78.46% of anembrionic pregnancies. Minor adverse effects occurred in 33.59% of the patients, and 84.99% of the patients reported they were satisfied. Medical treatment produced a cost saving of 960.54 Euros per patient. Conclusions: The success of medical treatment in our study was high, with misoprostol administration being effective in approximately 8 out of 10 patients. Misoprostol is highly accepted by patients and most reported that they were satisfied. The incidence of minor adverse effects was low, and these effects were well tolerated; consequently, their presence does not seem to restrict the application of this treatment. Misoprostol use helps to reduce healthcare costs

A twin pregnancy provided with ICSI, an abortion of the first fetus at the 18th week and live birth of the second fetus at the end of the 36th week: a case report and literature review.

OBJECTIVE: The aim of this report was to evaluate and present the fourth longest delay among twin and multiple pregnancies described in the literature. METHODS: How can we optimize the health of the remaining fetus or fetuses after spontaneous abortion of the first fetus in multiple pregnancies? By considering one of our cases, we try to answer that question in light of the published literature. RESULTS: In our case, the second fetus was born at the end of the 36th week after abortion of the first fetus at the beginning of the 18th week. Delayed interval delivery was postponed 132 gestational days. CONCLUSIONS: The implementation of delayed intentional delivery is a reliable and required approach especially for infertility patients when they are selected carefully and monitored closely.

Aborto espontáneo. Protocolo actualizado en julio de 2010 / No disponible

No disponible

Resolution of depression and grief during the first year after miscarriage: a randomized controlled clinical trial of couples-focused interventions.

AIMS: The purpose of this randomized controlled clinical trial was to examine the effects of three couples-focused interventions and a control condition on women and men's resolution of depression and grief during the first year after miscarriage. METHODS: Three hundred forty-one couples were randomly assigned to nurse caring (NC) (three counseling sessions), self-caring (SC) (three video and workbook modules), combined caring (CC) (one counseling session plus three SC modules), or control (no treatment). Interventions, based on Swanson's Caring Theory and Meaning of Miscarriage Model, were offered 1, 5, and 11 weeks after enrollment. Outcomes included depression (CES-D) and grief, pure grief (PG) and grief-related emotions (GRE). Differences in rates of recovery were estimated via multilevel modeling conducted in a Bayesian framework. RESULTS: Bayesian odds (BO) ranging from 3.0 to 7.9 favored NC over all other conditions for accelerating women's resolution of depression. BO of 3.2-6.6 favored NC and no treatment over SC and CC for resolving men's depression. BO of 3.1-7.0 favored all three interventions over no treatment for accelerating women's PG resolution, and BO of 18.7-22.6 favored NC and CC over SC or no treatment for resolving men's PG. BO ranging from 2.4 to 6.1 favored NC and SC over CC or no treatment for hastening women's resolution of GRE. BO from 3.5 to 17.9 favored NC, CC, and control over SC for resolving men's GRE. CONCLUSIONS: NC had the overall broadest positive impact on couples' resolution of grief and depression. In addition, grief resolution (PG and GRE) was accelerated by SC for women and CC for men.

Does dilation and curettage versus expectant management for spontaneous abortion in patients undergoing in vitro fertilization affect subsequent endometrial development?

In in vitro fertilization patients, treatment of spontaneous abortion with dilation and curettage (D&C) versus expectant management has no long-term effect on subsequent endometrial development, as measured by change in endometrial thickness. A transient reduction in endometrial thickness was found within the first 6 months after D&C, which is a novel finding, but it is likely to have little or no effect on pregnancy rates given the small absolute effect on endometrial thickness.