Safer Approach to Failed Early Pregnancy Treatment

(Ivanhoe Newswire) -- There may be a safer, more acceptable alternative to surgical treatment for women with failed early pregnancy, according to a new study.

One in four women experience early pregnancy failure due to reasons such as spontaneous abortion, anembryonic gestation, and embryonic or fetal death. The standard treatment involves scrapping the lining of the uterus to remove tissue, commonly known as dilatation and curettage, or D & C. Misoprostol or Cytotec -- a drug that causes uterine contractions -- has gained popularity due its prompt removal of pregnancy tissue.

"Misoprostol is increasingly used to treat women who have a failed pregnancy in the first trimester," says Jun Zhang, Ph.D., M.D., from the National Institute of Child Health and Human Development (NICHD). "However, the efficacy, safety and acceptability of this approach have yet to be established in a large, randomized trial."

Dr. Zhang and colleagues assigned 491 women to receive a vaginal dose of misoprostol and 161 women to undergo vacuum aspiration -- the removal of pregnancy tissue through suction. If removal did not occur by day three, the women randomized to misoprostol received a second dose. Vacuum aspiration was performed on day eight if removal still did not occur.

In the misoprostol group, 71 percent of the women experienced complete expulsion by day three, and 84 percent did by day eight. After 30 days, 16 percent of the women who received misoprostol and 3 percent of the vacuum aspiration group experienced treatment failure. Hospitalization due to hemorrhaging or endometritis was required for less than 1 percent of the women in each group.

"Treatment of early pregnancy failure with 800 microgram of misoprostol vaginally is a safe and acceptable approach, with a success rate of approximately 84 percent," study authors write. "The risks of hemorrhage and pelvic infection were very low, and the side effects were tolerable. Misoprostol treatment was acceptable to most women."

Of the misoprostol group, 78 percent of the women report they would use the method again if needed, while 83 percent would recommend the treatment to others.

The authors conclude, "Our experience, in accordance with that in other literature on medical abortion, suggests that hospitalizing patients for the misoprostol treatment is unnecessary. As long as clear instructions for monitoring bleeding and infection are given to women and emergency service is readily accessible, self-administration of misoprostol at home could increase the convenience and privacy and further reduce the cost." 
 
Copyright © 2005 Ivanhoe Broadcast News, Inc.

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SOURCE: The New England Journal of Medicine, 2005;353:761-769, 834-836