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Objectives To study if misoprostol 400 Ag, administered vaginally, increased the successful resolution of early miscarriage compared with placebo. Design Randomised, double blind placebo controlled study.Setting Sahlgrenska University Hospital, Göteborg, Sweden.Sample One hundred and twenty-six women seeking medical attention for early miscarriage.Method Women with a non-viable, first trimester miscarriage were randomised to vaginal administration of misoprostol 400 Ag or placebo. Main outcome measures Main outcome measure was the proportion of successful complete resolution of miscarriage. Secondary outcomes were incidence of infection, bleeding, gastrointestinal side effects, pain, use of analgesics and length of sick leave between groups. Results Sixty-four patients were randomised to misoprostol and 62 to placebo. Eighty-one percent in the misoprostol and 52% in the placebo group had a complete miscarriage within one week of the primary visit (RR 1.57; 95% CI 1.20-2.06). Patients in the misoprostol group reported more pain as assessed on a visual analogue scale (60.4 [31.0] vs 43.8 [37.1] mm; P < 0.007) and required analgesics more often (83% vs 61%, RR 1.35; 95% CI 1.08 -1.70). There were no significant differences in the occurrence of gastrointestinal side effects, infection, reduction in haemoglobin or sick leave between the groups. Conclusions Treatment with 400 Ag misoprostol administered vaginally increased the success rate of resolvement of uncomplicated early miscarriages compared with placebo. However, women who received misoprostol experienced more pain and required more analgesics than those who did not.

This study suggests that selective COX-2 inhibition has a negative, local effect on human ovulation, resulting in delayed follicular rupture, without affecting peripheral hormonal cyclicity.

Objective To describe the incidence of clinical miscarriage and to investigate the factors influencing the occurrence of clinical miscarriage.Design Prospective study with both cross-sectional and longitudinal comparisons.Setting City of Göteborg, Sweden.Population Population-based study in cohorts of 19-year-old women followed longitudinally.Main outcome measures Incidence of miscarriage and pregnancy outcome. Results Complete data were available for 341 women born in 1962 and assessed up to the age of 39 years (ever pregnant, n = 320, 94%). There were in total 887 pregnancies (live birth, n = 590, 67%; miscarriage, n = 108, 12%; legal abortion, n = 173, 20% and ectopic pregnancy, n = 16, 2%). Of the 320 'ever pregnant' women, 80 women (25%) had experienced a miscarriage. 76.3% had experienced one miscarriage, 16.3% had two miscarriages and 7.4% had three or more miscarriages. The clinical miscarriage rates in women at different ages were as follows: 20-24 years 13.5%, 25-29 years 12.3%, 30-34 years 10.3% and 35-39 years 17.5%. The corresponding miscarriage rate in the 1972 cohort followed from 19 to 29 years of age was 11%, and in the 1982 cohort assessed at 19 years of age, the miscarriage rate was 9%. No risk factor for miscarriage could be reliably identified.Conclusions Clinical miscarriage constituted 12% of all pregnancies, and one in four women who had been pregnant up to 39 years of age had experienced a miscarriage. Three or more miscarriages were experienced by 7.4%. The occurrence of a miscarriage was not influenced by the order of the pregnancy.Keywords Clinical miscarriage, contraception, epidemiology, pregnancy outcome, smoking.Please cite this paper as: Blohm F, Fridén B, Milsom I. A prospective longitudinal population-based study of clinical miscarriage in an urban Swedish population.