Early pregnancy loss treatment
Early pregnancy loss (EPL) is defined as a nonviable, intrauterine pregnancy within the first trimester (either anembryonic pregnancy or embryonic death). Unfortunately, it is common in the general population, and even more prevalent among sub-fertile women undergoing fertility treatments.Misoprostol (Cytotec) is an accepted treatment for EPL worldwide. Despite its widespread use, there is no consensus regarding the optimal treatment protocol, and the common practice differs greatly between clinics.
What is your current position?
- Ob/Gyn Resident
- Ob/Gyn specialist
- Fertility specialist
- Other
In what type of setting do you treat patients with early pregnancy loss (EPL)?
- Private clinic
- Public clinic
- University-affiliated clinic
In your opinion, what should be the first line of treatment in most women experiencing early pregnancy loss (EPL)?
- Expectant management
- Medical treatment
- Surgical evacuation
- I provide all relevant information and let the patient choose according to her own preference
How many patients with EPL do you treat every year?
- 1-20
- 21-51
- 51-100
- 101-200
- More than 200
Do you use misoprostol for EPL treatment in your practice?
- Yes
- No
Yes
Where does misoprostol treatment take place?
- At a medical facility
- At the patient’s home
Up to what gestational size (according to transvaginal sonography) do you administer misoprostol for EPL?
- 8-9 weeks
- 10-12 weeks
- 13-14 weeks
- Other
In the majority of cases, which route of misoprostol administration do you use?
- Vaginal
- Sublingual
- Oral
- Other
Which dose of vaginal/sublingual/oral/other misoprostol do you use?
- 400 mcg
- 600 mcg
- 800 mcg
- Other
When do you schedule the first follow-up visit?
- After 24 hours
- After 2-3 days
- After 4-6 days
- After one week
- After two weeks
- More than two weeks
In case of incomplete expulsion, do you administer a second dose of misoprostol?
- Yes
- No, I recommend surgical evacuation
- I provide counselling and the patient chooses whether or not to receive a second dose according to her own preference.
When do you make the final decision regarding treatment failure or success?
- After 24 hours
- After 2-3 days
- After 4-6 days
- After one week
- After two weeks
- After one month
- After the first menstrual period
- Other
What are your sonographic criteria for successful treatment?
- No gestational sac (regardless of endometrial thickness).
- No gestational sac and endometrial thickness is less than 30 mm
- No gestational sac and endometrial thickness is less than 20 mm
- No gestational sac and endometrial thickness is less than 15 mm
- No signs of residual products of conception.
- Other
- I do not perform a sonographic follow-up.
Do you combine misoprostol treatment with any other medications?
- No
- Yes, mifepristone (Mifegyne) pretreatment
- Yes, methotrexate
- Yes, oxytocin
- Other
In your opinion, what is the level of evidence regarding misoprostol treatment for EPL?
- Highest level of evidence
- Moderate level of evidence
- Low level of evidence. More studies are needed.
I would like to see more research data about the following issues (multiple answers allowed):
- Misoprostol dose
- Misoprostol route of administration
- Mifepristone pretreatment
- Timing and effectiveness of a second dose administration
- Criteria to decide on treatment failure of success
- Comparison between misoprostol and surgical evacuation
- Long-term consequences of misoprostol treatment
