A Comparison of Medical Management with Misoprostol and Surgical Management for Early Pregnancy Failure

Abstract

Treatment of early pregnancy failure with 800 microg of misoprostol vaginally is a safe and acceptable approach, with a success rate of approximately 84 percent.

Medical versus surgical treatment for early pregnancy loss in infertile patients: Which approach facilitates more rapid return to subsequent treatment cycle?

“…Miscarriage is the most common gynecological emergency (accounting for 75% of gynecological Emergency Room Visits in the United Kingdom [2]; and two previous studies demonstrated that 15% of patients who miscarry do so spontaneously in the first trimester [3,4]. Approximately one in four women will have an early pregnancy failure during her lifetime [4].…”

“…Approximately one in four women will have an early pregnancy failure during her lifetime [4]. Miscarriages in pregnancies achieved by assisted reproductive technology (ART) procedures may be slightly more frequent than in general population and occur in 16% -30% of patients with confirmed pregnancy [1,[5][6][7].…”

“…Success in either treatment is defined by abstaining from repeated surgical intervention or surgical treatment for patients who initial used the medical approach within the 30 days after initial treatment [4]. Previous studies have projected the overall expectant management of EPL to have a success rate of 25% (4,7).…”

“…Asherman's syndrome or intrauterine adhesions (IUA), is a well-known complication following any uterine surgery, such as post-D & C, and may lead to long-term complications including menstrual aberrations, infertility, recurrent pregnancy loss, and intrauterine growth restriction [11]. The advantages of D & C include the inherently high procedural success rate of 97% [4], and the possibility of analyzing the tissue for its chromosomal make-up.…”

“…Misoprostol has the advantage of being inexpensive, easily stored and readily available [10]. There are various dose regimens published in the literature, which report an average efficiency rate of 84% [4]. The remaining 16% of patients identified as treatment failures ultimately required a D & C to manage RPOC.…”