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Hum. Reprod. Advance Access published online on April 14, 2005
Human Reproduction, doi:10.1093/humrep/dei019
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received December 30, 2004
Revised March 6, 2005
Accepted March 14, 2005

Article

Misoprostol versus curettage in women with early pregnancy failure: impact on women's health-related quality of life. A randomized controlled trial

G.C.M. Graziosi 1*, H.W. Bruinse 2, P.J.H. Reuwer 3, P.H. van Kessel 4, P.E. Westerweel 2, and B.W. Mol 5

1 St Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
2 University Medical Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
3 St Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
4 Tweesteden Hospital, Dr Deelenlaan 5, 5042 AD, Tilburg, The Netherlands
5 Maxima Medical Centre, de Run 4600, 5504 DB, Veldhoven, The Netherlands

* To whom correspondence should be addressed.
G.C.M. Graziosi, E-mail: p.graziosi{at}Antonius.net


  Abstract

BACKGROUND: We aimed to compare patients' health-related quality of life after a misoprostol strategy to a curettage in women with early pregnancy failure after failed expectant management. METHODS: A multicentre randomized clinical trial was performed in The Netherlands. In all, 154 women with early pregnancy failure confirmed at ultrasonography who had been managed expectantly unsuccessfully for ≥1 week were randomly assigned to undergo either treatment with misoprostol (n=79) or curettage (n=75). The main outcome measures were health-related quality of life and satisfaction with treatment. RESULTS: In the misoprostol strategy 47% of the women needed additional curettage, as compared to 4% after curettage. In both groups, health-related quality of life was impaired most severely 2 days after treatment. In the misoprostol group, health-related quality of life was more severely impaired; after 2 days this was due to more pain and after 2 and 6 weeks this was due to a worse general health perception. Health-related quality of life was temporarily significantly more impaired in women in whom misoprostol failed as compared to women in whom misoprostol treatment was successful. In both treatment groups, an equal percentage of women (58%) would choose the same treatment in the future. In women treated with misoprostol, however, this choice depended on the initial success of misoprostol: in cases where misoprostol had caused complete evacuation, 76% of the women would opt for the same treatment, whereas only 38% of women who needed curettage after unsuccessful misoprostol would do so (P<0.01). CONCLUSION: Our study shows that, although both the misoprostol strategy and the curettage strategy resulted in complete evacuation in the end, women are willing to accept some disadvantages of misoprostol to avoid curettage. A treatment inconvenience using misoprostol is accepted as long as initial evacuation rate is high. This finding should be an integral part of counselling women when deciding upon management of early pregnancy failure.

Keywords: curettage; early pregnancy failure; misoprostol; quality of life.
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