# Sonographic Predictors and Outcomes of Second-Dose Misoprostol in Early Pregnancy Loss

## TL;DR

A second dose of misoprostol can help manage early pregnancy loss, with sonographic results after the first dose predicting the need for surgery.

## Contribution

The study evaluates the effectiveness of a second misoprostol dose and identifies sonographic predictors for successful treatment.

## Key findings

- A second dose of misoprostol achieved a 49% success rate for uterine evacuation without surgery.
- Delayed miscarriage and anembryonic pregnancy after the first dose increased odds of needing surgical intervention.
- Sonographic results after the first dose can forecast the need for surgical intervention.

## Abstract

Background: Misoprostol is a preferred medical agent for managing early pregnancy loss. However, the optimal protocol, particularly repeat dosing, remains a topic of debate.

Objective: To evaluate the effectiveness of a second dose of misoprostol in women with incomplete uterine evacuation after the first dose, and to examine sonographic findings and demographic data to identify factors associated with successful treatment.

Methods: Retrospective descriptive study of electronic medical records from a tertiary university-affiliated hospital. We identified women who had early pregnancy loss and received a second dose of misoprostol vaginally after an incomplete response to the first dose.

Results: A second dose of misoprostol achieved a 49% success rate for uterine evacuation without surgical intervention. Demographic and obstetric characteristics were similar in both the intervention and non-intervention groups; 44% of delayed miscarriages and 49% of anembryonic pregnancies with an intact sac persisted after the second dose (p<0.001). Delayed miscarriage and anembryonic pregnancy after the first dose significantly increased the odds of surgical intervention (delayed miscarriage: odds ratio (OR) 4.138, 95% confidence interval (CI) 1.513-11.317; anembryonic pregnancy: OR 2.921, 95% CI 1.349-6.326).

Conclusion: A second dose of misoprostol offers effective care. Sonographic results after the first dose help forecast the need for surgical intervention.