Medical vs. surgical evacuation of first‐trimester spontaneous abortion

Abstract

Objective: To determine whether management of incomplete first‐trimester abortion with vaginal misoprostol in an under‐resourced setting is a viable treatment option. Methods: A total of 94 women were randomized to 600 μg of misoprostol intravaginally or to surgical curettage. The women receiving misoprostol were administered a second dose if the abortion was incomplete; and if still not complete after a week, evacuation of retained products of conception was performed. All women had a follow‐up visit 2 weeks following complete abortion. Results: The overall success rate of medical management was 91.5%, with 15 of 47 successful cases after 1 dose of misoprostol; 8.5% of the 47 women required evacuation of retained products of conception after 1 week because of treatment failure. The success rate in the surgical arm was 100%. Patients in the medical arm had a longer duration of bleeding and a greater need for analgesia. There were no differences in hemoglobin levels, white blood cell count, adverse effects, pain score, and satisfaction with treatment at the follow‐up visit. However, more women who received the medical treatment would recommend it or choose it in the future. Conclusion: Medical management using 600 μg of misoprostol in 2 doses is effective to treat incomplete first‐trimester abortions in an under‐resourced setting when there is no evidence of uterine sepsis.