Expectant vs Medical Management for Retained Products of Conception After Medical Termination of Pregnancy: A Randomized Controlled Study

There has been an increase in the use ofmedical treatments for the termination of pregnancy. However, no prospective trials have evaluated the efficacy of misoprostol in treating retained products of conception following induced termination of pregnancy. The aim of this open-label randomized controlled trial was to compare the safety and efficacy of medical management of misoprostol with that of expectant management for retained products of conception after first-trimester medical termination of pregnancy. The study was conducted at a university-affiliated tertiary medical center. Participants were women who underwent medical termination of pregnancy and at a routine 3-week follow-up evaluation showed sonographic suspicion of retained products of conception (defined as sonographic evidence of intrauterine remnant >12 mm) with a positive Doppler flow. Subjects were randomized into 2 groups: (1) a medical treatment group receiving 800 mu g of sublingually administered misoprostol) or (2) expectant management. All patients underwent repeat ultrasound scans every 2 weeks up to a maximumof 6 weeks; women suspected of having persistent retained products of conception were referred to operative hysteroscopy. The primary study end point, successful treatment, was defined as avoiding the need for surgical intervention because of persistent retained products of conception within 8 weeks from pregnancy termination. There was no marked difference between the 2 groups in demographic characteristics. Median sonographic length of the retained products of conception was not significantly different: 20mm (interquartile range, 17-25mm) in the medically managed group and 20 mm (interquartile range, 17-26 mm) in the expectantly managed group (P = 0.733). Treatment was successful in both groups: 61.8% of women (42/68) in the medically managed group and 57.1% of women (36/63) in the expectantly managed group; the relative risk was 1.12, with a 95% confidence interval of 0.74 to 1.70; P = 0.590. Adverse outcomes in the 2 groups were not significantly different. These data showno clinicallymeaningful advantage formedical treatment withmisoprostol compared with expectantmanagement among women with suspected retained products of conception after first-trimester medical termination of pregnancy. Up to 60% of women managed expectantly for 8 weeks of follow-up can avoid surgical intervention.