Expectant Management Versus Drug Treatment with Oral Contraceptive Pills in the Elimination of Pregnancy Remnants Caused by Incomplete Spontaneous Abortion in the First Trimester of Pregnancy: A Randomized Clinical Trial
Archives of Advances in Biosciences,
Vol. 15 No. 1 (2024),
24 January 2024
,
Page 1-8
https://doi.org/10.22037/aab.v15i1.47132
Abstract
Introduction: Various medical, surgical, and recently expectant methods are being considered for the removal of the retained products of conception caused by incomplete abortion. We aimed to assess the effectiveness and safety of oral contraceptive pills (OCP) and expectant (waiting) methods in the successful removal of these remnants.
Materials and Methods: In this clinical trial, 58 patients were randomly treated with medication with OCPs, and the equivalent group of 58 patients were treated expectantly. The patients underwent treatment and intervention for three weeks, and then both groups underwent transvaginal ultrasound one week after the intervention to check whether they had successfully expelled the retained products of conception. The statistical software SPSS version 23.0 was used for the statistical analysis (IBM, Armonk, New York). P values of ≤ 0.05 were considered statistically significant.
Results: In terms of the success in removing the retained products from the abortion, this success in the two groups treated with OCP and expectant management were 84.5% and 86.2%, respectively, which did not show a difference between the two groups (p-value > 0.05). In terms of other outcomes after the intervention, including infection, bleeding, and abdominal pain, no significant difference was observed between the two groups (p-value > 0.05). There was no significant difference between the two groups in the duration of full recovery and return to daily activities (p-value > 0.05).
Conclusion: In the comparison of two medicinal methods regarding the complete disposal of abortion remnants, there is no difference in the success rate of the methods as well as the resulting complications including infection, pain, or bleeding. Also, the time to return to work and daily activities was similar in both groups.
- Abortion
- oral contraceptive
- expectant management
- pregnancy
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References
Erfani A. Abortion in Iran: What do we know?. PSC discussion papers series. 2008 Jan 2;22(1):1.[LINK]
Griebel CP, Halvorsen J, Golemon TB, Day AA. Management of spontaneous abortion. American family physician. 2005 Oct 1;72(7):1243-50.[PMID]
Chen BA, Creinin MD. Medical management of early pregnancy failure: efficacy. InSeminars in reproductive medicine 2008 Sep (Vol. 26, No. 05, pp. 411-422). © Thieme Medical Publishers.[DOI: 10.1055/s-0028-1087107] [PMID]
Nielsen S, Hahlin M. Expectant management of first-trimester spontaneous abortion. The Lancet. 1995 Jan 14;345(8942):84-5.
[DOI:10.1016/s0140-6736(95)90060-8]
Zhang J, Zhou K, Shan D, Luo X. Medical methods for first trimester abortion. Cochrane Database of Systematic Reviews. 2022(5).
[DOI:10.1002/14651858.cd002855.pub5] [PMID]
Hershko Klement A, Frederic M, Bentov Y, Chang P, Nayot D, Haas J, Casper RF. Oral contraceptive pills as an option for non-surgical management of retained products of conception–a preliminary study. Gynecological Endocrinology. 2018 Jul 3;34(7):609-11.
[PMID]
Sajan R, Pulikkathodi M, Vahab A, Kunjitty VM, Imrana HS. Expectant versus surgical management of early pregnancy miscarriages-A prospective study. Journal of Clinical and Diagnostic Research: JCDR. 2015 Oct 1;9(10):QC06.[PMID]
Dangalla DP, Goonewardene IM. Surgical treatment versus expectant care in the management of incomplete miscarriage: a randomised controlled trial. Ceylon Medical Journal. 2013 Jan 3;57(4).
[PMID]
Wijesinghe PS, Padumadasa GS, Palihawadana TS, Marleen FS. A trial of expectant management in incomplete miscarriage. Ceylon Medical Journal. 2011 Mar 25;56(1). [PMID]
Trinder J, Brocklehurst P, Porter R, Read M, Vyas S, Smith L. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). Bmj. 2006 May 25;332(7552):1235-40.[PMID]
Ankum WM, Wieringa-de Waard M, Bindels PJ. Management of spontaneous miscarriage in the first trimester: an example of putting informed shared decision making into practice. bmj. 2001 Jun 2;322(7298):1343-6. [ [PMID]
Sagili H, Divers M. Modern management of miscarriage. The Obstetrician & Gynaecologist. 2007 Apr;9(2):102-8. [LINK]
Fernlund A, Jokubkiene L, Sladkevicius P, Valentin L. Reproductive outcome after early miscarriage: comparing vaginal misoprostol treatment with expectant management in a planned secondary analysis of a randomized controlled trial. Ultrasound in Obstetrics & Gynecology. 2022 Jan;59(1):100-6. [PMID]
Wada Y, Takahashi H, Suzuki H, Ohashi M, Ogoyama M, Nagayama S, Baba Y, Usui R, Suzuki T, Ohkuchi A, Fujiwara H. Expectant management of retained products of conception following abortion: A retrospective cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2021 May 1;260:1-5. [PMID]
Ali MK, Emam SM, Abdel‐Aleem MA, Sobh AM. Retracted: Misoprostol versus expectant management in women with incomplete first‐trimester miscarriage after failed primary misoprostol treatment: A randomized clinical trial. International Journal of Gynecology & Obstetrics. 2021 Sep;154(3):558-64. [PMID]
Shelley JM, Healy D, Grover S. A randomised trial of surgical, medical and expectant management of first trimester spontaneous miscarriage. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2005 Apr;45(2):122-7. [PMID]
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