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Hum. Reprod. Advance Access originally published online on June 10, 2004
Human Reproduction 2004 19(8):1894-1899; doi:10.1093/humrep/deh344
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Human Reproduction vol. 19 no. 8 © European Society of Human Reproduction and Embryology 2004; all rights reserved

Misoprostol versus curettage in women with early pregnancy failure after initial expectant management: a randomized trial

G.C.M. Graziosi1,7, B.W.J. Mol2,3, P.J.H. Reuwer4, A. Drogtrop5 and H.W. Bruinse6

1 Department of Obstetrics and Gynaecology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 2 Department of Obstetrics and Gynaecology, Academic Medical Centre, Meibergdreef 9, Amsterdam, 3 Department of Obstetrics and Gynaecology, Maxima Medical Centre, De Run 4600, Veldhoven, 4 Department of Obstetrics and Gynaecology, St Elisabeth Hospital, Hilvarenbeekseweg 60, Tilburg, 5 Department of Obstetrics and Gynaecology, Tweesteden Hospital, Dr Deelenlaan 5, Tilburg and 6 Department of Obstetrics and Gynaecology, University Medical Centre, Heidelberglaan 100, Utrecht, The Netherlands

7 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, St Antonius Hospital, PO Box 2500, 3430 EM, Nieuwegein, The Netherlands. Email: p.graziosi{at}antonius.net

BACKGROUND: Little is known about the effectiveness of misoprostol treatment in women with early pregnancy failure who have been managed expectantly. We therefore performed a randomized trial on this subject. METHODS: Women with early pregnancy failure, who had been managed expectantly for at least 1 week, were assigned randomly (using a computer-generated list) to receive either vaginal misoprostol 800 µg or curettage. If, after 24 h, there had not been complete evacuation, a further 800 µg of misoprostol was administered. In the absence of complete evacuation after >3 days, curettage was performed. The primary end-point was the 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, 47% (37/79) required curettage due to incomplete evacuation. After 1 week, evacuation was complete in 85% (67 out of 79) of the misoprostol group and 93% (70 out of 75) of the curettage group. Severity of pain, bleeding and emergency evacuation was higher in the misoprostol group. The complication rate was 0% for misoprostol and 4% for curettage. CONCLUSIONS: Curettage is superior to misoprostol in the evacuation of early pregnancy failure after failed expectant management. However, misoprostol could be clinically useful since it reduces the need for curettage by half and has a lower complication rate, at the expense of increased pain, vaginal bleeding and emergency evacuation.

Key words: curettage/early pregnancy failure/expectant management/misoprostol/randomized trial


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