Success Rates of Expectant vs. Medical Management for Retained Products After First-Trimester Abortion: Randomized Controlled Trial

Study Goals:

• Primary Objectives: Evaluate the effectiveness of medical management with misoprostol and expectant management for retained products of conception (RPOC) following medical abortion for delayed miscarriage in the first trimester (up to 12 weeks).
• Secondary Objectives: Assess the safety and complications of expectant versus medical management of RPOC.

Study Design:

• Prospective study involving women diagnosed with RPOC following medical abortion with mifepristone and misoprostol for delayed miscarriage in the first trimester.
• Participants will be randomized into two groups: medical management with misoprostol and expectant management (observation only).
• Data will be collected through three follow-up visits over six weeks, with ultrasound evaluations to monitor uterine content and decide on further interventions, if necessary.

Population:

Women aged 18-45 diagnosed with delayed miscarriage up to 12 weeks gestation, with sonographic evidence of RPOC after medical abortion using mifepristone and misoprostol.

Inclusion criteria

• Age 18-45.
• RPOC identified on ultrasound after medical abortion, defined as endometrial thickness >10 mm with Doppler flow into the uterine cavity.
• Hemodynamically stable women with bleeding comparable to menstrual flow, without fever.

Exclusion criteria

• Hemodynamic instability, excessive bleeding, or fever.
• Endometrial thickness >40 mm.
• Endometrial thickness <10 mm without Doppler flow into the cavity.
• Presence of a gestational sac within the uterine cavity.
• Women who received two doses of misoprostol before evaluation. Study Duration:Five years.

Sample Size:

Based on previous studies, 124 women (62 per group) are required for 80% power at a 5% significance level. Accounting for potential attrition, a total of 150 participants will be recruited (75 in each group).

Data Collection:

• Demographic data (age, ethnicity, weight, height).
• Medical history (chronic conditions, medications).
• Obstetric and gynecologic history.
• Current pregnancy details (gestational age, method of conception).
• Sonographic data at diagnosis and follow-ups (endometrial thickness, RPOC dimensions, Doppler flow parameters).
• Complications during the process (surgical interventions, blood transfusions, infections, intrauterine adhesions).

Statistical Analysis:

Data will be analyzed using SPSS software. ANOVA will assess differences between groups on outcomes.

Confidentiality:

All data will be anonymized and stored securely, with access limited to the primary and co-investigators. Data will be retained for 15 years.

Inclusion criteria

• Age 18-45.
• RPOC identified on ultrasound after medical abortion, defined as endometrial thickness >10 mm with Doppler flow into the uterine cavity.
• Hemodynamically stable women with bleeding comparable to menstrual flow, without fever.

Exclusion criteria

• Hemodynamic instability, excessive bleeding, or fever.
• Endometrial thickness >40 mm.
• Endometrial thickness <10 mm without Doppler flow into the cavity.
• Presence of a gestational sac within the uterine cavity.
• Women who received two doses of misoprostol before evaluation.