Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem, P.O.B. 12000, 91120, Israel.
Department of Internal Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
BMC Womens Health. 2023 Oct 4;23(1):523. doi: 10.1186/s12905-023-02666-9.
To date, the association between retained placenta and treatment success rate of misoprostol for early pregnancy failure has yet to be evaluated. The aim of this study was to evaluate this association and further investigated the connection between medical, clinical and sonographic parameters and treatment success.
We conducted a retrospective cohort study of women with early pregnancy failure treated with misoprostol from 2006 to 2021. The success rate of misoprostol treatment was compared between patients with history of retained placenta including women who underwent manual lysis of the placenta following delivery or patients who were found to have retained products of conception during their post-partum period (study group) and patients without such history (controls). Demographic, clinical, and sonographic characteristics as well as treatment outcomes were compared between the groups.
A total of 271 women were included in the study (34 women in the study group compared to 237 women in the control group). Two-hundred and thirty-three women (86.0%) presented with missed abortion, and 38 (14.0%) with blighted ovum. Success rates of misoprostol treatment were 61.8% and 78.5% for the study and control groups, respectively (p = 0.032). Univariate analysis performed comparing successful vs. failed misoprostol treatment showed advanced age, gravidity, parity and gestational sac size (mm) on TVUS were associated with higher misoprostol treatment failure rate. Following a multivariate logistic regression model these variables did not reach statistical significance.
Women who have an event of retained placenta following childbirth appear to have decreased success rate of treatment with misoprostol for early pregnancy failure. Larger studies are needed to confirm this finding.
迄今为止，胎盘滞留与米索前列醇治疗早期妊娠失败的成功率之间的关系尚未得到评估。本研究旨在评估这种关联，并进一步研究医学、临床和超声参数与治疗成功之间的关系。
我们对 2006 年至 2021 年期间接受米索前列醇治疗的早期妊娠失败的女性进行了回顾性队列研究。比较了有胎盘滞留史的患者（包括产后行人工胎盘剥离术或产后发现有胎盘组织残留的患者，研究组）和无此类病史的患者（对照组）的米索前列醇治疗成功率。比较了两组患者的人口统计学、临床和超声特征以及治疗结局。
共纳入 271 例女性（研究组 34 例，对照组 237 例）。233 例（86.0%）表现为稽留流产，38 例（14.0%）为枯萎卵。研究组和对照组的米索前列醇治疗成功率分别为 61.8%和 78.5%（p=0.032）。比较成功与失败的米索前列醇治疗的单因素分析显示，高龄、孕次、产次和 TVUS 上的妊娠囊大小（mm）与米索前列醇治疗失败率升高相关。在多变量逻辑回归模型中，这些变量没有达到统计学意义。
分娩后有胎盘滞留事件的女性，使用米索前列醇治疗早期妊娠失败的成功率似乎降低。需要更大的研究来证实这一发现。
