Doctors can manage miscarriages with a nonsurgical treatment as effectively and as safely as surgery.
The treatment is called misoprostol, a pill used to prevent the risk of developing a stomach ulcer in people who take certain pain relievers.
The medication is also used "off label" by doctors to stimulate contractions of the uterus and is commonly used to induce labor and prevent or treat excessive bleeding after vaginal birth.
Physicians have begun prescribing misoprostol to women who have experienced a miscarriage early in pregnancy. The treatments most commonly offered to these women include surgery such as curettage or vacuum aspiration to empty the uterus of its contents.
How Safe Is It?
But is misoprostol effective? And, equally important, is it safe?
That's what the authors set out to explore.
The study appears in the New England Journal of Medicine.
Miscarriage occurs in one out of four women, or 15 percent of pregnancies, write the authors. In fact, they add, pregnancy failure in the first trimester is one of the most common reasons for women to seek emergency services.
In their study, Jun Zang, a researcher at the National Institutes of Health, and his colleagues enrolled 652 women who had experienced miscarriages. Of these women, 491 were given a prescription for misoprostol, and the rest underwent vacuum aspiration.
The women in the misoprostol group underwent vacuum aspiration if the vaginal pill failed.
The researchers show that most women who received misoprostol (84 percent) had successfully experienced complete uterine expulsion within eight days of receiving treatment without the need for surgery.
For 16 percent of the misoprostol group, treatment failed. In contrast, 3 percent of the vacuum aspiration group experienced treatment failure and had to undergo the procedure again.
Complications from either treatment -- uterine hemorrhage and uterine infection -- were rare, occurring in less than 1 percent of each group.
Of the women in the misoprostol group, 78 percent say they would choose the drug again if they needed to. Eighty-three percent say they would recommend it to other women.
Because misoprostol causes uterine contractions, women who are treated with it may experience some abdominal pain and cramping, says Zhang. In cases where minor pain is present, he recommends ibuprofen. More intense pain can be treated with codeine.
"In conclusion, misoprostol treatment provides an effective alternative for women who prefer to avoid the surgical procedure. Moreover, because it can be done on an outpatient basis, misoprostol treatment is less expensive and can provide women more privacy than vacuum aspiration," he says.
By Patti Connor, reviewed by Brunilda Nazario, MD
SOURCES: Zhang, J. The New England Journal of Medicine, Aug. 25, 2005; vol 353; pp. 671-769. News release, National Institute of Child Health and Human Development.
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