Ultrasonographic Endometrial Thickness After Medical and Surgical Management of Early Pregnancy Failure

We sought to compare endometrial thickness after misoprostol or dilation and curettage (DC) for early pregnancy failure and to assess the predictive value of endometrial thickness for subsequent DC after misoprostol treatment.In a randomized trial of early pregnancy failure management, 491 women were treated with misoprostol vaginally, and 161 were treated with DC. Transvaginal ultrasonography was planned for 2 and 14 days after misoprostol treatment, and 14 days after DC.The mean endometrial thickness 14 days after treatment was 9.0 mm for the misoprostol group and 6.9 mm for the DC group, (difference 2.1 mm, 95% confidence interval [CI] 1.0-3.2). After the ultrasonograms 2 and 14 days after misoprostol, 13 (3.8%) and 12 (3.2%) women, respectively, subsequently underwent DC. Women requiring DC after successful expulsion had significantly greater endometrial thickness than those who did not at 2 days (mean difference 5.2 mm, 95% CI 1.6-8.8) and 14 days (mean difference 5.5 mm, 95% CI 2.3-8.8) after misoprostol. However, endometrial thickness was a poor predictor of subsequent DC. The areas under the receiver operating characteristic curves for endometrial thickness at 2 and 14 days were 0.71 and 0.73, respectively. Regardless of cutoff values used for predicting subsequent DC, endometrial thickness had a positive predictive value of 40% or less.The difference in endometrial thickness between misoprostol treatment and DC for early pregnancy failure is not clinically significant. Endometrial thickness is not a useful predictor of subsequent surgical intervention after successful expulsion of the gestational sac after misoprostol for early pregnancy failure.ClinicalTrials.gov,www.clinicaltrials.gov, NCT00177333I.