What is Medical Expulsive Therapy (MET)?
Medical Expulsive Therapy (MET) involves the use of medications to facilitate the expulsion of uterine or adnexal contents. This therapy is particularly relevant in managing conditions like incomplete miscarriages, missed abortions, or retained products of conception. The goal is to avoid surgical interventions by using pharmacological agents that induce uterine contractions and expulsion of retained tissue.
Indications for MET
MET is commonly indicated in the following scenarios:Common Medications Used
The most commonly used medications in MET include: Misoprostol: A prostaglandin E1 analog that induces uterine contractions. It is often used alone or in combination with mifepristone.
Mifepristone: An antiprogestogen that sensitizes the uterus to prostaglandins and is often used prior to misoprostol.
Methylergonovine: An ergot alkaloid that induces uterine contractions and is sometimes used in cases of postpartum hemorrhage or RPOC.
How Effective is MET?
The effectiveness of MET varies depending on factors such as the type and duration of the condition, the dosage and route of administration of the medications, and patient-specific factors. Studies have shown that the combination of mifepristone and misoprostol has a high success rate, often exceeding 90% in cases of early pregnancy failure. Misoprostol alone is also highly effective but may have slightly lower success rates compared to combination therapy.
Advantages and Disadvantages
MET offers several advantages, including: Non-Invasive: Avoids the need for surgical procedures like dilation and curettage (D&C).
Cost-Effective: Generally less expensive than surgical options.
Convenient: Can often be administered in an outpatient setting.
However, there are also some disadvantages:
Side Effects: Misoprostol can cause cramping, bleeding, nausea, vomiting, diarrhea, and fever.
Incomplete Expulsion: There is a risk of incomplete expulsion, which may eventually require surgical intervention.
Patient Compliance: Requires patient adherence to the medication regimen and follow-up visits.
Contraindications
MET is not suitable for everyone. Contraindications include: Allergy to any of the medications used.
Hemorrhagic Disorders: Conditions that increase the risk of severe bleeding.
Ectopic Pregnancy: Requires surgical intervention due to the risk of rupture.
Severe Anemia: Patients with severe anemia may not tolerate the blood loss associated with MET.
Follow-Up and Monitoring
After initiating MET, close follow-up is essential. Patients should be monitored for signs of successful expulsion, such as the passage of tissue and cessation of bleeding. Ultrasound imaging is often used to confirm complete expulsion. Additionally, patients should be educated about potential side effects and advised to seek medical attention if they experience severe pain, heavy bleeding, or signs of infection.Conclusion
Medical Expulsive Therapy is a valuable option in gynecology for managing conditions like incomplete miscarriage, missed abortion, and retained products of conception. It offers a non-invasive, cost-effective alternative to surgical intervention. However, careful patient selection, monitoring, and follow-up are crucial to ensure successful outcomes and manage potential complications.
