Medical Option Now Available After Miscarriage

Until recently, if a woman had a miscarriage early in her pregnancy, doctors often had to perform surgery to remove any remaining fetal tissue.

But according to new study findings, the medication misoprostol also may be an option after pregnancy loss.

The researchers found that misoprostol was effective in expelling fetal tissue in 84 percent of the women studied. "Basically, our study was a comparison of medical management versus surgical management for early pregnancy failure," said the study's lead author, Dr. Jun Zhang, an investigator at the National Institutes of Health in Bethesda, Md.

Misoprostol and surgery had "pretty much the same complication rate, and acceptability rates are almost identical," said Zhang. "Surgical treatment is 97 percent effective, but it's invasive."

The findings appear in the Aug. 25 issue of the New England Journal of Medicine.

Misoprostol is one of the medications used in elective medical abortions; the other is mifepristone (RU486). Misoprostol, which was originally developed to prevent ulcers, causes the uterus to contract and is sometimes used to induce labor.

Miscarriage occurs in at least 10 percent of pregnancies, according to the National Library of Medicine, often between seven and 12 weeks gestation. Symptoms include abdominal or back pain, cramping and vaginal bleeding.

If any fetal tissue remains, the current standard of care calls for a surgical procedure known as dilation and curettage (D&C) to clear the uterus, according to Zhang. While D&C is considered a minor procedure, it does entail the use of either local or general anesthesia. Vacuum aspiration is another option to empty the uterus.

Because the loss of a pregnancy is often a difficult emotional period for a woman, the researchers wanted to learn if drug treatment could be a faster, less invasive option for women.

To do so, the researchers asked 652 women with a first-trimester pregnancy failure to participate in the study. Four hundred ninety-one women were assigned to receive misoprostol vaginally; the remaining 161 underwent vacuum aspiration.

Misoprostol treatment was effective for 84 percent of the women, while vacuum aspiration was effective in 97 percent of the cases. Complications occurred in less than 1 percent of the women in either group.

When asked if they would recommend this procedure to others, 83 percent of the women in both groups said that they would. Asked if they would undergo the same procedure again, 78 percent in the misoprostol group said they would, while 75 percent in the vacuum aspiration group would.

"It's a choice issue," said Zhang. "Would you prefer medical management rather than surgical treatment?"

Dr. Beverly Winikoff, president of Gynuity Health Projects in New York City, said many doctors already offer medical management as an option. Winikoff wrote an accompanying editorial in the same issue of the journal.

"I think this is something women will appreciate. Many women would probably prefer not having surgery," she said.

Medical management of early pregnancy loss may have the most impact in developing countries where access to surgical care isn't always reliable, Winikoff said. "In developing countries, often there are no good or available services. Some women don't have access at all. [Misoprostol] is something that could easily be given in dispensaries," she said.

By Serena Gordon
HealthDay Reporter (8-24-2005)

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