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Objectives
To review clinical practice outcomes of early pregnancy loss (EPL) medical management
at a previous mifepristone-misoprostol clinical trial site after study completion.
Methods
We reviewed a de-identified database for patients who received mifepristone-misoprostol
for EPL from May 2018 to May 2021 at our academic center–based clinic, which was a
study site for the mifepristone-misoprostol EPL trial (completed March 2018). All
patients received mifepristone 200 mg and misoprostol 800 mcg with clinic follow-up
typically scheduled within one week. We analyzed management and safety outcomes.
Results
Ninety-one patients chose medical management with mifepristone followed by misoprostol
vaginally (79[87%]) or buccally (5[5%]), with route not documented for seven patients
(8%). Median gestational age was 49 days (range 30–80) and median time from mifepristone
to misoprostol administration was 24 hours (range 8–66). Follow-up was completed in
the clinic for 80 (88%) patients, completed remotely for six (6%), and not completed
for five (5%). Most patients (80[88%]) were successfully managed with medications
alone. Two patients (2%) required tissue removal from the cervical os with ring forceps
and nine (10%) had uterine aspirations. Seventy patients initially had ultrasonography
at follow-up showing gestational sac expulsion; three (4%) ultimately required an
aspiration for bleeding with pathologic examination demonstrating villi for all. The
only safety outcomes were one pelvic infection and one transfusion due to significant
bleeding.
Conclusions
Outside of a clinical trial setting, medical management of EPL with mifepristone and
misoprostol remains effective and safe. While gestational sac expulsion on ultrasonography
remains a good indicator of successful medical management of EPL, subsequent aspiration
may be required more frequently than after medication abortion.
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Copyright
© 2022 Published by Elsevier Inc.
