Vaginal misoprostol 0.4-0.6 mg is effective in most patients with missed abortion. Pre-treatment with the antiprogesterone mifepristone does not increase the success rate. The selection of women with missed abortion for medical treatment based on gestational age and initial p-hCG level may increase the success of medical treatment significantly.

The aim of this study was to compare expectant management, misoprostol applied vaginally and surgical evacuation in women with incomplete spontaneous abortion. Materials and methodsThe three gynecologic departments in Herlev, Gentofte and Glostrup, Copenhagen County participated in this prospective crossover study with alternating treatments every 4 months during 1 year. The entry criteria to the study were: 1) fresh bleeding; and 2) positive urine human chorionic gonadotrophine (hCG) or plasma-hCG Ͼ 30 IU/l; and 3) a trans-vaginal ultrasound (US) demonstrating retained products of conception with an anterior-posterior diameter of 15-50 mm; and 4) crown rump length (CRL) Ͻ50 mm with no cardiac activity if a fetus was visible.The exclusion criteria were: age below 18 years, suspicion of ectopic pregnancy, allergy or contraindications against misoprostol, sign of infection, heavy bleeding demanding acute evacuation or women not speaking Danish. The three treatment regimens were:C Acta Obstet Gynecol Scand 81 (2002)

Vaginal misoprostol 0.4-0.6 mg is effective in most patients with missed abortion. Pre-treatment with the antiprogesterone mifepristone does not increase the success rate. The selection of women with missed abortion for medical treatment based on gestational age and initial p-hCG level may increase the success of medical treatment significantly.

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