Hormone pattern after misoprostol administration for a nonviable first-trimester gestation

Objective: To evaluate serial hormone concentrations in subjects treated with vaginally administered misoprostol for early pregnancy failure. Design: As part of a randomized clinical trial, serum was collected on treatment days 1, 3, 8, and 15. Setting: Multicenter clinical trial. Patient(s): Women with a nonviable first-trimester pregnancy. Intervention(s): Serum concentrations of human chorionic gonadotropin (hCG), progesterone, and sex hormone binding globulin (SHBG) were evaluated. Main Outcome Measure(s): A logistic regression model was constructed to assess the associations of percent and complete expulsion of the gestational sac and/or successful management. Result(s): The percent change from the day of treatment until the first follow-up visit was predictive for complete expulsion for progesterone (P) (P < .005) and hCG (P < .005), but not for SHBG. The actual value was not significantly associated with complete expulsion or Successful management. A decrease (day 1-3) of 79% for both hCG and P was associated with a 90% probability of complete passage of the gestational sac. A 90% probability of successful management was noted if P decreased by 78% on day 3 or 59% on day 7, or hCG decreased by 74% on day 3 or 78% on day 7 compared with pretreatment values. Conclusion(s): Percent change, but not absolute change, in serial hormone values are strongly associated with both the complete expulsion of the gestational sac with one dose of misoprostol and ultimate success. (Fertil Steril(R) 2004;81:1099-105. (C) 2004 by American Society for Reproductive Medicine.).