COMPARISON OF MANAGEMENT OPTIONS FOR EPL

Advantages Disadvantages Estimated Rates of Success
Expectant Management
  • Non-invasive; body expels non-viable pregnancy
  • Perceived as natural by patients
  • Avoids anesthesia and surgery risks if successful
  • Process is unpredictable; can last days to weeks
  • Can have prolonged or heavy bleeding and cramping
  • Despite waiting, may still require uterine aspiration or other intervention
Incomplete EPL:

  • Day 7: 50%
  • Day 14: 70-85%
  • Day 46: 90%

Other types of EPL:

  • Day 7: 23-30%
  • Day 14: 35-60%
  • Day 46: 65-75%

(Nanda 2012, Casikar 2010, Luise 2002)

Medical Management
(With misoprostol)
  • Non-invasive
  • Safe
  • Highly effective
  • Avoids medication, anesthesia and surgery risks if successful
  • Highly cost-effective
  • May cause heavier or stronger cramping than aspiration
  • May cause short-term gastrointestinal & other side effects
  • May still need uterine aspiration
Incomplete EPL:

  • Single Dose 96%

Other types of EPL:

  • Single Dose 71%
  • Second Dose 84%
  • Higher efficacy when no embryro/fetus or cardiac motion detected on US

(Ngoc 2013, Neilson 2013, Zhang 2005)

Office-based Aspiration
  • Predictable
  • Offers fastest resolution
  • Less bleeding than expectant or medication
  • Low probability of further treatment need (<5%)
  • Pain control with local plus oral or IV meds
  • Compared to OR:
    • Cost & resource savings
    • Improved patient access,
    • continuity and privacy
    • Less patient & staff time
  • Rare risks of invasive procedure
  • Less pain control options in some settings compared to an in-hospital procedure
  • 98-100%

 

(Nanda 2012)

Operating Room Aspiration Can be asleep
Predictable
Less time / bleeding than expectant or medication
Low probably of further treatment need (<5%)
More cost, time, exams than office-based procedures
Risks associated with invasive procedure; general anesthesia
May be more bleeding complications with general anesthesia vs. office procedure
  • 98-100%

 

(Nanda 2012)

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