Early pregnancy loss (EPL)—including missed, incomplete and
inevitable abortion—is a common clinical outcome, experienced by approximately
1 million women every year.1 Currently, management of EPL includes expectant,
medical and surgical options. Previous literature demonstrated that
misoprostol, a prostaglandin E1 analogue, is most effective in patients
diagnosed with incomplete or inevitable abortion, and especially in those who
present with symptoms such as cramping and bleeding.2 However many women are diagnosed
with EPL by ultrasound, prior to onset of symptoms. Among women diagnosed with
anembryonic gestation and embryonic or fetal demise, in which symptoms of EPL
are less common, a single dose of misoprostol will effectively complete an
abortion in only 81% to 88%, respectively. A second dose of misoprostol can
increase the rate of expulsion3 but this delay in success is associated with
increased costs to both patients and the health care system, including more
office visits, ultrasound examinations, and patient anxiety. While medical
management with misoprostol is an important alternative option to observation
or a surgical procedure, we’ve all had patients for whom medical management
resulted in a prolonged and frustrating process during a sensitive time.
Wouldn’t it be great if we had a medical option that resulted in a more
expeditious and safer resolution of pregnancy loss?
No comments:
Post a Comment