Abstract：
To analyze the success rate, time to passage of tissue and subjective patient experience of a newly implemented protocol for medical management of early pregnancy failure (EPF) over a 2-year period.
A retrospective chart review of all patients with early pregnancy failure primarily opting for medical management was performed. 200 mg mifepristone were administered orally, followed by a single vaginal dose of 800 mcg misoprostol after 36-48 h. We followed-up with our patients using a written questionnaire.
167 women were included in the present study. We observed an overall success rate of 92 %, defined as no need for surgical management after medication administration. We could not identify predictive values for success in a multivariate regression analysis. Most patients (84 %) passed tissue within 6 h after misoprostol administration. The protocol was well tolerated with a low incidence of side effects. Pain was managed well with sufficient analgesics. Responders to the questionnaire felt adequately informed prior to treatment and rated their overall experience as positive.
The adaption of the institutional medical protocol resulted in a marked improvement of success rate when compared to the previously used protocol (92 vs. 61 %). We credit this increase to the adjusted medication schema as well as to targeted physician education on the expected course and interpretation of outcome measures. Our results underscore that the medical management of EPF is a safe and effective alternative to surgical evacuation in the clinical setting.
A retrospective chart review of all patients with early pregnancy failure primarily opting for medical management was performed. 200 mg mifepristone were administered orally, followed by a single vaginal dose of 800 mcg misoprostol after 36-48 h. We followed-up with our patients using a written questionnaire.
167 women were included in the present study. We observed an overall success rate of 92 %, defined as no need for surgical management after medication administration. We could not identify predictive values for success in a multivariate regression analysis. Most patients (84 %) passed tissue within 6 h after misoprostol administration. The protocol was well tolerated with a low incidence of side effects. Pain was managed well with sufficient analgesics. Responders to the questionnaire felt adequately informed prior to treatment and rated their overall experience as positive.
The adaption of the institutional medical protocol resulted in a marked improvement of success rate when compared to the previously used protocol (92 vs. 61 %). We credit this increase to the adjusted medication schema as well as to targeted physician education on the expected course and interpretation of outcome measures. Our results underscore that the medical management of EPF is a safe and effective alternative to surgical evacuation in the clinical setting.
摘要：
分析成功率，新实施的早期妊娠失败医学管理方案（EPF）在2年内的组织时间和患者主观体验。
对所有早期妊娠失败患者进行回顾性分析，主要选择药物治疗。口服200毫克米非司酮，36-48h后，单次阴道剂量为800mcg米索前列醇。我们使用书面问卷对患者进行了随访。
本研究纳入了167名女性。我们观察到总体成功率为92%，定义为用药后不需要手术管理。我们无法在多元回归分析中确定成功的预测值。大多数患者（84％）在米索前列醇给药后6小时内通过组织。该方案耐受性良好，副作用发生率低。使用足够的镇痛药可以很好地控制疼痛。问卷的答复者在治疗前感到充分了解，并将他们的总体经验评为积极。
与以前使用的方案相比，机构医疗方案的适应显著提高了成功率(92vs.61%）。我们将这一增长归功于调整后的药物方案以及对预期课程的针对性医生教育和对结果指标的解释。我们的结果强调，在临床环境中，EPF的医疗管理是手术后送的安全有效替代方法。
对所有早期妊娠失败患者进行回顾性分析，主要选择药物治疗。口服200毫克米非司酮，36-48h后，单次阴道剂量为800mcg米索前列醇。我们使用书面问卷对患者进行了随访。
本研究纳入了167名女性。我们观察到总体成功率为92%，定义为用药后不需要手术管理。我们无法在多元回归分析中确定成功的预测值。大多数患者（84％）在米索前列醇给药后6小时内通过组织。该方案耐受性良好，副作用发生率低。使用足够的镇痛药可以很好地控制疼痛。问卷的答复者在治疗前感到充分了解，并将他们的总体经验评为积极。
与以前使用的方案相比，机构医疗方案的适应显著提高了成功率(92vs.61%）。我们将这一增长归功于调整后的药物方案以及对预期课程的针对性医生教育和对结果指标的解释。我们的结果强调，在临床环境中，EPF的医疗管理是手术后送的安全有效替代方法。
