Medical Management of Early Pregnancy Failure: How to Treat and What to Expect

Abstract

Medical management is gaining acceptance as a treatment option for women with early pregnancy failure (EPF). We reviewed randomized trials comparing misoprostol for EPF with surgical (dilation and curettage) or expectant management. Overall, approximately 85% of women with EPF can expect complete uterine evacuation after one or two doses of 600 or 800 microg misoprostol without surgery. Medical management is safe. As with surgical therapy, serious complications are rare. Women undergoing medical management of EPF may expect moderate pain and bleeding for several days, which may persist for 2 weeks or longer. Side effects associated with misoprostol are common; however, acceptability of medical management remains high.

Potential predictors for successful misoprostol treatment for early pregnancy failure: Clinical and color Doppler imaging study

“…Failure of medical treatment with misoprostol for EPF ranges from 10% to 50% compared with 0-4% after surgical management (13). Medical induction, with misoprostol, of normal pregnancy has a failure rate of 5% (14).…”

Misoprostol treatment vs expectant management in women with early non‐viable pregnancy and vaginal bleeding: a pragmatic randomized controlled trial

“…The number of patients treated with antibiotics (including those prescribed antibiotics), making unplanned visits, being hospitalized and taking sick-leave was also recorded. A diagnosis of endometritis was assigned to patients with low abdominal or pelvic pain and/or Follow-up day 17 (14)(15)(16)(17)(18)(19)(20)(21) (n = 29) Failed to appear (n = 1) Follow-up day 17 (14)(15)(16)(17)(18)(19)(20)(21) (n = 44) Failed to appear (n = 2)…”

“…Surgical evacuation and medical treatment are alternative methods to empty the uterus after miscarriage, but one can also await spontaneous emptying [13][14][15] .…”

Management of early pregnancy failure

“…There is no evidence to show a differential risk of infection by management choice (13). l Expectant management has a lower incidence of infection (RR 0.29, 95% CI 0.09-0.87) l Although differences were found between expectant versus surgical management, none of these differences were clinically serious l Patient preference should guide decision-making (18) Misoprostol: Route, Dose, and Safety l There is published literature on a wide range of therapeutic regimens (1,12,19). l Optimal dose and route of administration of misoprostol have not been determined by randomized trials.…”