Lemmers Marike, Verschoor Marianne A C, Oude Rengerink Katrien, Naaktgeboren Christiana, Bossuyt Patrick M, Huirne Judith A F, Janssen Ineke A H, Radder Celine, Klinkert Ellen R, Langenveld Josje, van der Voet Lucet, Siemens F Frederike, Bongers Marlies Y, van Hooff Marcel H, van der Ploeg Marinus, Sjors F P J, Coppus S F P J, Ankum W M, Mol Ben Willem J
Department of Obstetrics and Gynaecology, Academic Medical Center, P.O. Box 22770, 1100 DE Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Department of Obstetrics and Gynaecology, Academic Medical Center, P.O. Box 22770, 1100 DE Amsterdam, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2017 Apr;211:83-89. doi: 10.1016/j.ejogrb.2017.01.019. Epub 2017 Jan 27.
To assess the effectiveness of curettage versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage.
We conducted a multicenter cohort study alongside a randomized clinical trial (RCT) between June 2012 until July 2014. 27 Dutch hospitals participated. Women with an incomplete evacuation after misoprostol treatment for first trimester miscarriage who declined to participate in the RCT, received treatment of their preference; curettage (n=65) or expectant management (n=132). A successful outcome was defined as an empty uterus on sonography at six weeks or uneventful clinical follow-up. We furthermore assessed complication rate and (re)intervention rate RESULTS: Of the 197 women who declined to participate in the RCT, 65 preferred curettage and 132 expectant management. A successful outcome was observed in 62/65 women (95%) in the surgical group versus 112/132 women (85%) in the expectant group (RR 1.1, 95% CI 1.03-1.2), with complication rates of 6.2% versus 2.3%, respectively (RR 2.7, 95% CI 0.6-12).
In women with an incomplete evacuation of the uterus after misoprostol treatment, expectant management is an effective and safe option. This finding could restrain the use of curettage in women that have used misoprostol in the treatment of first trimester miscarriage.
评估米索前列醇治疗早期流产后子宫排空不全的女性患者中，刮宫术与期待治疗的有效性。
我们在2012年6月至2014年7月期间进行了一项多中心队列研究以及一项随机临床试验（RCT）。27家荷兰医院参与其中。米索前列醇治疗早期流产后子宫排空不全但拒绝参与RCT的女性患者，接受其偏好的治疗；刮宫术（n = 65）或期待治疗（n = 132）。成功结局定义为六周时超声检查子宫为空，或临床随访平稳。我们还评估了并发症发生率和（再次）干预率。结果：在197名拒绝参与RCT的女性中，65人选择刮宫术，132人选择期待治疗。手术组65名女性中有62人（95%）获得成功结局，而期待治疗组132名女性中有112人（85%）获得成功结局（相对危险度1.1，95%可信区间1.03 - 1.2），并发症发生率分别为6.2%和2.3%（相对危险度2.7，95%可信区间0.6 - 12）。
米索前列醇治疗后子宫排空不全的女性患者中，期待治疗是一种有效且安全的选择。这一发现可能会限制在早期流产治疗中使用过米索前列醇的女性患者刮宫术的应用。
