Medical treatment of second-trimester fetal miscarriage : a retrospective analysis
Niinimäki, Maarit; Mentula, Maarit; Jahangiri, Reetta; Männistö, Jaana; Haverinen, Annina; Heikinheimo, Oskari (2017-07-28)
Niinimäki M, Mentula M, Jahangiri R, Männistö J, Haverinen A, Heikinheimo O (2017) Medical treatment of second-trimester fetal miscarriage; A retrospective analysis. PLoS ONE 12(7): e0182198. https://doi.org/10.1371/journal.pone.0182198
Copyright: © 2017 Niinimäki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objectives: Research on the treatment of second-trimester miscarriages is scarce. We studied the outcomes, and the factors associated with adverse events and need for hospital resources in the medical treatment of second-trimester miscarriage.
Materials and methods: In these retrospective analyses we studied women treated for spontaneous fetal miscarriage with misoprostol-only (n = 24) or mifepristone and misoprostol (n = 177) in duration of gestation 12+1–21+6. Primary outcomes were the risk factors for surgical evacuation and excessive bleeding. Secondary outcomes were total misoprostol dose, time to expulsion and the length of hospital stay.
Results: History of surgical evacuation of the uterus increased the risk of surgical evacuation (p = 0.027). Excessive bleeding was not associated with any of the studied variables. More misoprostol was needed when the duration of gestation exceeded 17+0 weeks (p = 0.036). In multivariate analysis the time to fetal expulsion was shorter in women with history of 1–2 deliveries (hazard ratio [HR] 1.49, 95% confidence interval [CI]; 1.07–2.07), ≥3 deliveries (HR 1.63, 95% CI; 1.11–2.38) and with a two-day interval between mifepristone-misoprostol administration (HR 1.71, 95% CI; 1.05–2.81). Patients with symptoms (i.e. uterine bleeding or pain) at baseline had longer hospital stay (HR 0.66, 95% CI; 0.47–0.92).
Conclusions The factors affecting the outcomes of medical treatment of second-trimester fetal miscarriage are similar to those of second-trimester induced abortion. Two-day interval between mifepristone-misoprostol administration might decrease the time to fetal expulsion and the need of hospital resources.
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