The standard treatment for RPOC is D&C. However, this brings a risk of intrauterine synechiae and subsequent fertility issues. A treatment strategy to avoid D&C is medical management with misoprostol. The justification for misoprostol in this setting is extrapolated from miscarriage and termination literature. However, no studies have explicitly looked into the environment of RPOC. The purpose of this study is to determine the efficacy of misoprostol as definitive management of RPOC.
Patients diagnosed with RPOC with clinical symptoms and ultrasound findings of endometrial mass and doppler flow treated expectantly, medically with vaginal misoprostol or with a suction D&C underwent a chart review.
One thousand seven hundred forty-three unique pregnancies were explored. Out of them,189 women were diagnosed with RPOC. 34% chose misoprostol for management of RPOC. Baseline demographics between the three treatment modalities were comparable. 65% of patients who took misoprostol avoided D&C. Misoprostol is most effective in the setting of RPOC if the primary treatment for miscarriage was expectant management, with less success with immediate medical management and quick surgical management.
Reference: https://www.tandfonline.com/doi/full/10.1080/13625187.2020.1807498
