Predictors of failed medical management in women with early pregnancy loss
Notice bibliographique
Résumé
Objectives: While medical management has been used to treat early pregnancy loss for over two decades, there remains a paucity of reliable predictors of treatment efficacy. The principal goal of this thesis is to identify new factors influencing medical management failure in women with first trimester pregnancy loss. Two objectives will be discussed. The first aim is to assess the effect of menstrual gestational age on the efficacy of misoprostol, in a population of women with a low sonographic gestational age. The second objective is to assess the value of uterine content ultrasound (US) measurements in predicting medical management failure in women with early pregnancy loss.Research design and methods: Two retrospective observational studies were conducted, each corresponding to a thesis objective. Both studies are based on a cohort of women with early pregnancy loss having visited the Emergency Department (ED) of the Jewish General Hospital, Montreal, Canada, between 2011 and 2013. Only women having been discharged with an outpatient prescription for misoprostol were included in out studies. With respect to the first objective, women had to have an US gestational age below 8 weeks. Exposure of interest consisted of menstrual age. In regards to the second objective, all women with US imaging available for review were included. Exposure of interest was uterine content measurements including: content anteroposterior distance (CAPD), content longitudinal distance, content transverse distance and uterine content volume. For both studies, logistic regression was used to estimate the effect of exposure on failed medical management defined as need for dilatation and curettage (D&C) or unplanned return to the ED (URED). Results: Increasing menstrual age was associated with an increased risk of D&C and URED. Specifically, risk of D&C and URED was 13.64% at ≤ 8 weeks and 26.32% at > 8 weeks, p < 0.05. Among uterine content measurements evaluated, CAPD was found to be independently associated with D&C and URED. When using an APD cutoff of 15mm, women were more likely to require D&C, 2.65 (1.31 - 5.36), p < 0.01 and to have an URED, 2.59 (1.41 - 4.79), p < 0.01. Conclusion: Both clinical and sonographic factors play a role in predicting successful medical management of early pregnancy loss. Increasing menstrual gestational age is associated with an increased risk of failed medical management regardless of US estimated gestational age. Furthermore, women with a uterine CAPD below 15mm on US should be considered good candidates for successful medical management. Although there is a need for further validation, combining current predictors of misoprostol efficacy with menstrual gestational age and ultrasonographic measurements of uterine CAPD may be helpful in selecting patients with first trimester pregnancy failure that can safely be managed medically.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».