Comparative Efficacy of Expectant Management, Oral Contraceptive Pills and Misoprostol for Management of Retained Products of Conception following Miscarriage: A Randomized Controlled Trial

Recent evidence supports improved outcomes with expectant/alternative medically treated clearance of retained products of conception (RPOCs) in post-miscarriage pregnancy when compared with misoprostol management.  There are few retrospectives, randomized controlled trials where the rates of the clearance of RPOCs were low or unchanged among expectantly managed or with oral contraceptive (OCP) use and managed with misoprostol group, whereas few trials showed an increase in the rate the clearance of RPOCs. Hence, there is a critical uncertainty about the effect of expectant management or OCP use on expulsion of RPOCs. In our study, 159  subjects with post-miscarriage retained products of conception of size 1-2.5 cm(measured in longest dimension) will be randomized into three groups: expectant management, medical management with oral contraceptive pills and medical management with misoprostol where expectantly managed and OCP used group will be compared with misoprostol group .

Expectant management is the clearance of retained products of conception post miscarriage pregnancy in the absence of any pharmacologic or mechanical initiation. Medical management is any pharmacological intervention required for attaining the desired clearance of RPOCs here by using synthetic prostaglandin E1 (Misoprostol) Or by using oral hormone containing contraceptive pills constituting ethinylestradiol, levonorgestral and ferrous fumarate.