Abstract
Objective
This study aimed to evaluate the efficacy of mifepristone combined with misoprostol in first-trimester missed miscarriages. We also aimed to determine ideal cutoff values of clinical indicators to predict the need for surgical intervention for an incomplete abortion.
Methods
A cohort of 702 consecutive women diagnosed with missed miscarriages between January 2020 and May 2023 was retrospectively analyzed. Demographic and ultrasound parameters such as endometrial thickness, mean diameter of the mass, hCG levels before and 24 h, 1 week, 2 weeks, and 1 month after treatment were measured and compared. ROC was used to determine cut-off values for incomplete abortion.
Results
Overall, 146 patients were treated with mifepristone and misoprostol (medication group), and 556 patients underwent curettage (surgical group). The endometrial thickness and postoperative vaginal bleeding duration of the medication group were greater than those of the surgical group one month post-treatment (P < 0.05), and the menstrual volume reduction rate in the medication group was significantly lower than that in the surgical group (23.56%). Sixteen patients experienced incomplete abortion (2.88%) in the surgical group and underwent another curettage procedure, while 25 patients (17.12%) in the medication group had incomplete abortion. Fourteen patients (9.59%) in the medication group underwent curettage because of incomplete abortion, which was a significantly higher rate than that in the surgical group. Eleven patients with incomplete abortion in the medication group received long-term medication, and the residual tissue in the uterine cavity disappeared after 1–2 menstrual cycles. The ultrasound cutoff values indicating the need for surgical intervention for an incomplete abortion were an endometrial thickness > 1.21 cm at 24 h after medication abortion and a uterine residual diameter > 0.95 cm at 7 days after surgical abortion.
Conclusion
The efficacy of mifepristone combined with misoprostol for first-trimester missed miscarriages is equivalent to that of curettage. Ultrasonography should be periodically reviewed after treatment. Patients with an endometrial thickness > 1.21 cm 24 h after a medication abortion and postoperative residual uterine diameter > 0.95 cm 7 days should be vigilant against incomplete abortion.