Potential predictors for successful misoprostol treatment for early pregnancy failure: Clinical and color Doppler imaging study

Abstract Objective To identify the clinical characteristics and features of color Doppler imaging related to successful misoprostol treatment for early pregnancy failure. Design Prospective observational study. Main outcome measures Factors related to successful misoprostol treatment for early pregnancy failure. Materials and methods Four groups of women with early pregnancy failure (missed, anembryonic and incomplete miscarriage) were included in the study. The first group included 159 cases, 73 were presenting with active vaginal bleeding and/or localized abdominal colic in the 24 h preceding misoprostol administration and 86 cases were not presenting with these symptoms. The parity of all participants was ⩾2. The second group included 143 cases that did not present with vaginal bleeding and/or abdominal colic. The parity was 0–1 in 66 cases and ⩾2 in 77 cases. The third group included 34 cases of missed miscarriage and 22 cases of anembryonic pregnancy presenting with active vaginal bleeding and/or localized abdominal colic and the parity was 0–1.The fourth group included 172 women, blood flow was detected by color Doppler imaging in the trophoblastic tissue in 90 cases and was absent in 82 cases. All participants in this group did not present with vaginal bleeding and/or localized abdominal colic and their parity was ⩾2. All participants in the four groups were given 800 μg vaginal misoprostol on day 1 of treatment. If the miscarriage was not complete on day 3 the same dose was repeated. On day 8 they were submitted to dilatation and evacuation if miscarriage was not complete. Miscarriage was considered complete when no gestation sac was detected in the uterine cavity on transvaginal ultrasonography. Results First group: the success rate of the two doses of misoprostol, when active vaginal bleeding and/or localized abdominal colic were present, was 94.52% (69 out of 73 cases). In absence of these symptoms the success rate was 75.58% (65 out of 86 cases). The difference was statistically ( p  = 0.0241) significant. Second group: the success rate of the two doses of misoprostol, when parity was 0–1, was 98.48% (65 cases out of 66). When parity was ⩾2 the success rate was 85.71% (60 cases out of 77). The difference was statistically ( p  = 0.0442) significant. Third group: the success rate of the first dose of misoprostol for missed miscarriage was 97.05%, 33 cases out of 34 cases and 100% for anembryonic miscarriage, 22 out of 22 cases. One case of missed miscarriage needed a second dose of misoprostol to complete the miscarriage. Fourth group: the success rate of the two doses of misoprostol, when blood flow was detected in the IVS of missed miscarriage and anembryonic pregnancy, was 100.0% (62 out of 62 cases). When blood flow was not detected in the IVS the success rate was 83.92% (47 out of 56 cases). The difference was statistically ( p  = 0.0422) significant. When blood flow (vascularity) was detected in the trophoblastic tissue of incomplete miscarriage the success rate was 75.0% (21 out of 28 cases) but when no blood flow (vascularity) was detected the success rate was 100% (26 out of 26 cases). The difference was statistically ( p  = 0.0331) significant. Conclusions The potential predictors for successful misoprostol treatment for early pregnancy failure may be one or more of the following: 1. Active vaginal bleeding and/or localized abdominal colic in the 24 h preceding misoprostol administration. 2. Nulliparity or low parity not more than 1. 3. Blood flow in the presumed IVS of missed miscarriage or anembryonic pregnancy and absence of blood flow (vascularity) in trophoblastic tissue of incomplete miscarriage. Women, with early pregnancy failure, presenting with a combination of active vaginal bleeding and/or abdominal colic and parity 0–1, the success rate of the first-dose of vaginal misoprostol (800 μg) may reach >97% in missed miscarriage and 100% with anembryonic pregnancy.