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 70Reproductive Health and ContraceptionReproductive System and PregnancyPregnancy and Medication Impact

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

Muffley, Patrick E., Stitely, Michael L., Gherman, Robert B.·2002·American Journal of Obstetrics and Gynecology

DOI 10.1067/mob.2002.126205

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Abstract

Objective The purpose of this study was to determine whether medical treatment of early pregnancy failure represents a reasonable alternative to surgical therapy. Study design Patients who were diagnosed with pregnancy failure before 12 weeks of gestation were randomly assigned to receive either medical (intravaginal misoprostol) or surgical therapy (dilatation and curettage). In the medical arm of the study, 800 microg of misoprostol was placed within the posterior vaginal fornix. Patients subsequently were seen 24 and 48 hours after the initial dosing; intravaginal misoprostol was readministered only if ultrasound images revealed evidence of persistent pregnancy tissue. By 72 hours after initial study entry, if either a gestational sac or placental tissue was present, the medical treatment was considered a failure, and uterine curettage was performed. Statistical analysis was performed with the two-tailed unpaired t test, chi(2) analysis, Fisher exact test, and Mann-Whitney U test; a probability value of <.05 was considered statistically significant. Results A total of 50 women were enrolled, with 2 patients in the surgical arm experiencing spontaneous pregnancy loss before their scheduled procedures. Twenty-five women received medical therapy; 25 women were randomized to surgical procedure. Fifteen patients in the medical group (60%; 95% CI, 0.41-0.79) had successful pregnancy termination and did not require curettage. There were no significant differences between the medical and surgical groups with respect to either posttreatment hematocrit level or the time needed to achieve negative human chorionic gonadotropin test results. Conclusion Intravaginal misoprostol is an effective agent for the treatment of early pregnancy failure. Medical treatment of early pregnancy failure represents a reasonable alternative to immediate surgical therapy.

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Randomised trials have shown that outpatient use of misoprostol is possible, with success rates of 72-93%.
“Randomised trials have shown that this is possible, with success rates of 72-93%.10,13-15,28-31”
From Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial) (2006) · cites this paper as [14]
Nine randomised controlled trials have compared medical and surgical management of miscarriage.
“Nine randomised controlled trials have compared medical and surgical management.2,8-15”
From Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial) (2006) · cites this paper as [14]

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Oral vs Vaginal Misoprostol for Medical Termination of Pregnancy
Garg, R., Roy, P., Singh, K., Nadkarni, A., & Sahoo, L. N. (2024) · Journal of South Asian Federation of Obstetrics and Gynaecology · doi:10.5005/jp-journals-10006-2200

A prospective randomized control trial comparing medical and surgical treatment for early pregnancy failure
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Early Pregnancy Failure: Medical versus Surgical Management
Begum, N., Akhter, S., & Laila, L. (2021) · Journal of Armed Forces Medical College Bangladesh · doi:10.3329/jafmc.v16i2.55302
Misoprostol is an acceptable alternative to surgical management for early pregnancy failure
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A Comparison of Medical Management with Misoprostol and Surgical Management for Early Pregnancy Failure
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Mifepristone and misoprostol for the treatment of early pregnancy failure: a pilot clinical trial
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Authors: Muffley, P. E., Stitely, M. L., & Gherman, R. B.
Affiliations: Naval Medical Center Portsmouth (US)
ORCID: Stitely, Michael L.
Gherman, Robert B.
Venue: American Journal of Obstetrics and Gynecology
Publisher: Elsevier BV
Published: 2002-08
Volume: 187
Issue: 2
Pages: 321-326
ISSN: 0002-9378 (ISSN-L)
DOI: 10.1067/mob.2002.126205
OpenAlex: W2156338732
Cited by: 70
References: 20
Citations by year: 2024: 1 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 4 · 2019: 3 · 2018: 1 · 2017: 1 · 2016: 3 · 2015: 2 · 2014: 1 · 2013: 3 · 2012: 1
FWCI: 7.05
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: American Journal of Obstetrics and Gynecology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
Keywords: early pregnancy failure, miscarriage, intravaginal misoprostol, dilatation and curettage, abortion, uterine curettage, human chorionic gonadotropin, postpartum hemorrhage
MeSH terms: Abortifacient Agents, Nonsteroidal, Abortion, Spontaneous, Administration, Intravaginal, Adolescent, Adult, Dilatation and Curettage, Female, Humans, Middle Aged, Pregnancy, Misoprostol

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

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