Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul 28;12(7):e0182198.
doi: 10.1371/journal.pone.0182198. eCollection 2017.

Medical treatment of second-trimester fetal miscarriage; A retrospective analysis

Maarit Niinimäki  1 , Maarit Mentula  2 , Reetta Jahangiri  1 , Jaana Männistö  1 , Annina Haverinen  2 , Oskari Heikinheimo  2
Affiliations

Medical treatment of second-trimester fetal miscarriage; A retrospective analysis

Maarit Niinimäki et al. PLoS One. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Similar articles

See all similar articles

Cited by

References

    1. NICE Clinical guideline 2012. Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage. - PubMed
    1. McNamee KM, Dawood F, Farquharson RG. Mid-trimester pregnancy loss. Obstet Gynecol Clinics North America 2014;41(1):87–102. - PubMed
    1. Kolte AM, Bernardi LA, Christiansen OB, Quenby S, Farquharson RG, Goddijn M, et al. Terminology for pregnancy loss prior to viability: a consensus statement from the ESHRE early pregnancy special interest group. Hum Reprod 2015;30(3):495–8. doi: 10.1093/humrep/deu299 - DOI - PubMed
    1. WHO Regional Strategy on Sexual and Reproductive Health. Definitions and indicators in family planning, maternal and child health and reproductive health. Geneva: World Health Organization, 2001.
    1. Kim C, Barnard S, Neilson JP, Hickey M, Vazquez JC, Dou L. Medical treatment for incomplete miscarriage. Cochrane Database of Systematic Reviews 2017, Issue 1.Art. No.:CD007223. - PMC - PubMed