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Medical Management of Early Pregnancy Failure: A Reasonable Option

Misoprostol is an effective and safe alternative to surgical treatment for early incomplete spontaneous abortion.

About one in four women suffers an early pregnancy loss during her lifetime. Historically, early pregnancy failure has been managed with dilatation and curettage, but recently, clinicians have questioned whether surgical treatment is always necessary. Although expectant management is an option for early incomplete spontaneous abortion, its success rate is suboptimal. In a randomized multicenter trial, investigators compared the efficacy of misoprostol (800 µg given vaginally) with that of vacuum aspiration (standard of care) in 652 women; 491 were assigned to misoprostol, and 161 were assigned to vacuum aspiration.

Women assigned to misoprostol received it on day 1 and again on day 3 if expulsion was incomplete and underwent vacuum aspiration on day 8 if expulsion still was incomplete. Treatment failure, defined as aspiration in the misoprostol group and repeat aspiration within 30 days in the surgical group, occurred in 16% versus 3%, respectively. Expulsion in the misoprostol group was complete by day 3 in 71% and by day 8 in 84%. Complications were rare in both groups, and 78% of women who received misoprostol said that they would take it again.

Comment: Although the failure rate associated with misoprostol is a bit higher than that with surgical management of early pregnancy failure, these data support the safety and efficacy of misoprostol for this off-label purpose. An editorialist notes that medical management is less expensive than surgical treatment and offers an alternative when surgical facilities and expertise are not readily available.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine September 16, 2005

Citation(s):

Zhang J et al. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med 2005 Aug 25; 353:761-9.

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• Medline abstract (Free)

Winikoff B. Pregnancy failure and misoprostol — Time for a change. N Engl J Med 2005 Aug 25; 353:834-6.

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• Medline abstract (Free)