Misoprostol treatment for early pregnancy loss – an international survey

Abstract Research question What is the global variability in misoprostol treatment for the management of early pregnancy loss (EPL)? Design An international web-based survey of fertility specialists and Ob/Gyn clinicians was conducted between August and November 2020. The survey consisted of 16 questions addressing several aspects of misoprostol treatment for EPL. Results Overall, 309 clinicians from 80 countries participated in the survey, out of whom 67.3% were fertility specialists. Nearly half (47.9%) of the respondents let the patient choose the first line of treatment (expectant management, misoprostol treatment, or surgical aspiration) according to her own preference. The 248 respondents who administer misoprostol in their daily practice were asked further questions; 59.7% of them advise patients to take the medication at home. The most common dose and route of administration is 800 mcg administered vaginally. Only 28.6% of the participants use mifepristone pretreatment. There is a large variability in the timing of the first follow-up visit after misoprostol administration, which ranges between 24 hours and one week in most clinics. In case of incomplete expulsion, only 42.3% of the respondents routinely administer a second dose. The timing of the final visit and the definition of successful treatment also differ greatly among the respondents. Conclusions There is large variability in the use of misoprostol for the management of EPL. High-quality research is necessary in order to examine several aspects of the treatment. Particularly, the timing and effectiveness of a second dose administration and the criteria to decide on treatment failure or success deserve more research in the future.