Early intrauterine pregnancy failure : a randomized trial of medical versus surgical treatment

Abstract EN

Little is known about the effectiveness of misoprostol treatment in women with early pregnancy failure who have been managed expectantly.

Therefore, a randomized trial on this subject was performed at Ibn Sina College of Medicine, Jeddah, between January, 2005 to January, 2007.

Methods : Women with early pregnancy failure, who has been managed expectantly for at least one week, were assigned randomly (using a computer-generated list) to receive either vaginal misoprostol or curettage.

If after 24 hours, there had not been complete evacuation, a further dose of misoprostol was administrated.

The primary end-point was complete evacuation of the products of conception, with secondary end-points being the occurrence of side effects, pain intensity, need for analgesics, and intensity and duration of bleeding.

Results : In the misoprostol group, 55 % (25 / 45) required no curettage with complete evacuation, compared with 100 % complete evacuation in curettage group.

Severity of pain, bleeding and emergency evacuation was higher in the misoprostol group (6, 5.1) and 9 (20 %) respectively.

Conclusions : Curettage is superior to misoprostol in the evacuation of early pregnancy failure.

However, misoprostol could be clinically useful since it reduce the need for curettage by half and has a lower complication rate, at the expense of increased pain, vaginal bleeding and emergency evacuation.