Lemmers M, Verschoor M A C, Overwater K, Bossuyt P M, Hendriks D, Hemelaar M, Schutte J M, Adriaanse A H, Ankum W M, Huirne J A F, Mol B W J
Department of Obstetrics and Gynaecology, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, VU Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
Department of Obstetrics and Gynaecology, Academic Medical Centre, P.O. Box 22770, 1100 DE, Amsterdam, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2017 Apr;211:78-82. doi: 10.1016/j.ejogrb.2017.01.055. Epub 2017 Jan 30.
To assess fertility and obstetric outcomes in women treated with curettage or undergoing expectant management for an incomplete miscarriage after misoprostol treatment.
Between June 2012 and July 2014, we conducted a multicentre randomised clinical trial (RCT) with a parallel cohort study for non-randomised women, treated according to their preference. In the RCT 30 women were allocated curettage and 29 expectant management. In the cohort 197 women participated; 65 underwent curettage and 132 women underwent expectant management. Primary outcome was curation, defined as either an empty uterus on sonography at six weeks or an uneventful clinical follow-up. We used questionnaires to assess fertility and obstetric outcome of the first new pregnancy subsequent to study enrolment.
Curation was seen in 91/95 women treated with curettage (95.8%) versus 134/161 women managed expectantly (83.2%) (p=0.003). The response rate was 211/255 (82%). In 198 women pursuing a new pregnancy, conception rates were 92% (67/73) in the curettage group versus 96% (120/125) in the expectant management group (OR 0.96, 95% CI 0.89;1.03, p=0.34), with ongoing pregnancy rates of 87% (58/67) versus 78% (94/120), respectively (OR 1.12, 95% CI 0.99;1.28, p=0.226). Preterm birth rates were 1/46 in the curettage group versus 8/81 in the expectant management group (OR 0.22, 95% CI 0.03;1.71 P=0.15). Caesarean section rates were 23% and 24% for women in the curettage group and expectant management group respectively.
In women with an incomplete evacuation of the uterus after misoprostol treatment, curettage and expectant management does not lead to different fertility and pregnancy outcomes, as compared to expectant management.
评估米索前列醇治疗后行刮宫术或期待治疗的不全流产女性的生育能力和产科结局。
2012年6月至2014年7月，我们进行了一项多中心随机临床试验（RCT），并对非随机分组的女性进行了平行队列研究，根据她们的偏好进行治疗。在RCT中，30名女性被分配接受刮宫术，29名女性接受期待治疗。在队列研究中，197名女性参与；65名接受刮宫术，132名女性接受期待治疗。主要结局是清宫，定义为六周时超声检查子宫为空或临床随访顺利。我们使用问卷评估研究入组后首次新妊娠的生育能力和产科结局。
刮宫术治疗的95名女性中有91名（95.8%）清宫，而期待治疗的161名女性中有134名（83.2%）清宫（p=0.003）。应答率为211/255（82%）。在198名寻求新妊娠的女性中，刮宫术组的受孕率为92%（67/73），期待治疗组为96%（120/125）（比值比0.96，95%可信区间0.89；1.03，p=0.34），持续妊娠率分别为87%（58/67）和78%（94/120）（比值比1.12，95%可信区间0.99；1.28，p=0.226）。刮宫术组的早产率为1/46，期待治疗组为8/81（比值比0.22，95%可信区间0.03；1.71，P=0.15）。刮宫术组和期待治疗组女性的剖宫产率分别为23%和24%。
米索前列醇治疗后子宫排空不全的女性中与期待治疗相比，刮宫术和期待治疗不会导致不同的生育能力和妊娠结局。
