Journal of investigative surgery : the official journal of the Academy of Surgical Research · 2025
Sonographic Endometrial Characteristics Associated with Subsequent Surgical Intervention After Medical Termination of Early Pregnancy Loss: A Single-Center Retrospective Cohort Study.
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Au Heng-Kien, Tsai Meng-Chen, Chien Li-Wei, Fu Hao-Sheng
Аннотация
BACKGROUND: This study aimed to identify factors of surgical intervention following medical termination of pregnancy (MTOP) of early pregnancy loss (EPL), using gestational age determined by transvaginal ultrasonography.
METHODS: A retrospective study was conducted of women who underwent MTOP for EPL at a single tertiary hospital between 2010 and 2019. The treatment protocol consisted of oral mifepristone (600 mg), followed by oral misoprostol (600 mcg) 48 h later. A transvaginal ultrasound was performed 14-16 days after mifepristone administration to evaluate endometrial morphology. Patients were classified into three groups according to ultrasound-determined gestational age. MTOP failure was defined as the need for surgical evacuation.
RESULTS: Among the 534 patients, 39 (7.3%) required surgical management. Gestational age ≤7+ weeks was not associated with MTOP outcomes. All women exhibiting a linear endometrial midline or homogeneous endometrium appearance achieved complete uterine evacuation (p < 0.001). Multivariate logistic regression identified increased endometrium thickness (adjusted odds ratio [aOR]: 1.43, 95% CI: 1.25-1.62, p < 0.001) and non-clear endometrial-myometrial margin (aOR: 8.88, 95% CI: 3.26-24.15, p < 0.001) as factors associated with MTOPs failure.
CONCLUSIONS: Sonographic endometrial assessment approximately two weeks after MTOP provides clinically relevant indicators of treatment success.
METHODS: A retrospective study was conducted of women who underwent MTOP for EPL at a single tertiary hospital between 2010 and 2019. The treatment protocol consisted of oral mifepristone (600 mg), followed by oral misoprostol (600 mcg) 48 h later. A transvaginal ultrasound was performed 14-16 days after mifepristone administration to evaluate endometrial morphology. Patients were classified into three groups according to ultrasound-determined gestational age. MTOP failure was defined as the need for surgical evacuation.
RESULTS: Among the 534 patients, 39 (7.3%) required surgical management. Gestational age ≤7+ weeks was not associated with MTOP outcomes. All women exhibiting a linear endometrial midline or homogeneous endometrium appearance achieved complete uterine evacuation (p < 0.001). Multivariate logistic regression identified increased endometrium thickness (adjusted odds ratio [aOR]: 1.43, 95% CI: 1.25-1.62, p < 0.001) and non-clear endometrial-myometrial margin (aOR: 8.88, 95% CI: 3.26-24.15, p < 0.001) as factors associated with MTOPs failure.
CONCLUSIONS: Sonographic endometrial assessment approximately two weeks after MTOP provides clinically relevant indicators of treatment success.