Early intrauterine pregnancy failure: A randomized trial of medical versus surgical treatment

Muffley, Patrick E.; Stitely, Michael L.; Gherman, Robert B.

doi:10.1067/mob.2002.126205

Cited by 61 publications

(42 citation statements)

References 18 publications

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“…This argues favorably for misoprostol treatment as a promising alternative to surgery and expectant treatment. Similar to our findings, Muffley et al 22 reported no serious adverse events in 25 women who were treated with misoprostol. However, of 25 subjects who were assigned randomly to curettage, one subject underwent laparotomy for uterine perforation.…”

Section: Commentsupporting

confidence: 92%

“…This is a more encompassing time frame than is used by other investigators, who commonly define outcome within 1 week of treatment. 22,23 Despite this, three subjects had curettage on extended follow-up. Overall, 26% of the subjects called study personnel for reassurance.…”

Section: Commentmentioning

confidence: 99%

“…22,24 Our high incidence of side effects is likely due to a more meticulous collection of subjects' complaints through diaries and interviews. Despite the frequency of reported side effects, most women find the treatment acceptable and would recommend it to others.…”

Section: Commentmentioning

confidence: 99%

See 2 more Smart Citations

A randomized trial of saline solution–moistened misoprostol versus dry misoprostol for first-trimester pregnancy failure

Gilles

Creinin

Barnhart

et al. 2004

American Journal of Obstetrics and Gynecology

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Objective-The purpose of this study was to estimate whether the efficacy of treatment with intravaginal misoprostol for first-trimester pregnancy failure is enhanced by the addition of saline solution.Study design-Eighty women with embryonic/fetal death or anembryonic pregnancy were assigned randomly to receive either 800 μg of misoprostol with saline solution (group I, 41 women) or without (group II, 39 women). Treatment was repeated on day 3 if the gestational sac remained. Curettage was performed if the gestational sac remained on day 8 or as necessary during at least 30 days of follow-up. Data were analyzed with the Student t test and the χ 2 or Fisher exact test.Results-By the first follow-up visit, 73% (group I) and 64% (group II) of women passed the gestational sac (P = .38). By the second follow-up visit, expulsion rates were 83% and 87%, respectively (P = .59). Five subjects in each group underwent curettage. Conclusion-Misoprostol is effective for the treatment of failed first-trimester pregnancy. The expulsion rate is not improved by adding saline solution. KeywordsMissed abortion; Misoprostol; Anembryonic pregnancy; Fetal death; Spontaneous abortion Approximately 15% of clinically evident pregnancies result in first-trimester loss. 1 Curettage, commonly performed for this condition, is comparatively costly when performed in the operating room. 2 Although curettage is relatively safe, it can be associated with intrauterine infection, adhesion, perforation, and cervical stenosis. 3 An alternative may be expectant or medical treatment. Expectant treatment usually results in the complete expulsion of the products of conception 4 ; however, the interval after diagnosis and expulsion varies. Luise et al 5 reported that most women passed products within 2 weeks of diagnosis. Jurkovic et al 6 found only a 25% success rate in women whose cases were followed for >6 weeks. MedicalReprints not available from the authors. NIH Public Access Author ManuscriptAm J Obstet Gynecol. Author manuscript; available in PMC 2010 May 10.Published in final edited form as: Am J Obstet Gynecol. 2004 February ; 190(2): 389-394. doi:10.1016/j.ajog.2003 NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript treatment may provide prompt expulsion and avoid costs and complications that are associated with surgery and the uncertainties of expectant treatment.A uterotonic drug that is proposed for medical treatment is misoprostol, an inexpensive widely available prostaglandin E 1 analog that is stable at room temperature. 7,8 The drug is absorbed through mucous membranes and can be administered sublingually, orally, vaginally, and rectally. 9,10 Misoprostol used alone for nonviable first-trimester pregnancy resulted in uterine expulsion in 13% to 96% of women. 11,12 Explanations for this wide range include different indications for treatment, dosing regimen, routes of administration, and measures of success. Vaginal administration appears to be more effective than oral administration for the inducement of ut...

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Section: Commentsupporting

confidence: 92%

Section: Commentmentioning

confidence: 99%

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A randomized trial of saline solution–moistened misoprostol versus dry misoprostol for first-trimester pregnancy failure

Gilles

Creinin

Barnhart

et al. 2004

American Journal of Obstetrics and Gynecology

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show abstract

“…4,5 Medical management with vaginal misoprostol will result in a completed miscarriage in 60-90% of patients. [4][5][6][7] Expectant management has the greatest variation in success rates, ending in a completed miscarriage for 38-81% of patients. [8][9][10] Although expectant management has been shown to increase overall days of bleeding and the risk of unscheduled surgical intervention or hospitalization, 8,11 patient satisfaction rates remain high for all approaches.…”

mentioning

confidence: 98%

Increasing the management options for early pregnancy loss: the economics of miscarriage

Strand¹

2015

American Journal of Obstetrics and Gynecology

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“…The use of misoprostol for the medical management of early pregnancy failure is an effective alternative to vacuum aspiration (1)(2)(3)(4)(5)(6), and an attractive alternative in patients who may be at greater risk for surgical complications. We present the case of a 43-year-old patient with morbid obesity, cardiovascular disease, and other medical comorbidities who underwent treatment for early pregnancy failure with the use of vaginal misoprostol during inpatient observation.…”

mentioning

confidence: 99%

Medical management of early pregnancy failure in a patient with coronary artery disease

Hackney

Creinin

Simhan

2007

Fertility and Sterility

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Early intrauterine pregnancy failure: A randomized trial of medical versus surgical treatment

Cited by 61 publications

References 18 publications

A randomized trial of saline solution–moistened misoprostol versus dry misoprostol for first-trimester pregnancy failure

A randomized trial of saline solution–moistened misoprostol versus dry misoprostol for first-trimester pregnancy failure

Increasing the management options for early pregnancy loss: the economics of miscarriage

Medical management of early pregnancy failure in a patient with coronary artery disease

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