A comparison of medical management with misoprostol

Question 1

When and where published

Answer 1

August 2005

New England Journal of Medicine

Question 2

Authors

Answer 2

Zhang, Gilles

Question 3

Study design

Answer 3

March 2002 - March 2004

Multicentre 4 hospitals in the USA non inferiority trial

Question 4

Primary outcome

Answer 4

‘Success’
For the miso group not having an vaccum aspiration
FOr the vaccum group - not having to have it repeated.

Question 5

Inclusion criteria

Answer 5

652 woman with first trimester pregnancy failure

Question 6

Method

Answer 6

At enrollment - med Hx, Hb, Rh status, physical exam \Centralised computed automated telephone reponse system assigned to a group 3:1 ratio
Contacted on D8 for a review of sx / emergency visits
FU day 15
Used 800 micrograms of misoprostol in the posterior fornix with a spec
Returned D 3 for review, and if not complete expulsion of products, then a second 800 mcg dose was given.On D8 vaccum aspiration was offered.
Each visit had TV USS

Surgical management was surgical manual vaccum aspiration in an outpatient setting either in OP setting or in OT

Miso vs surgical ERPOC 3:1 ratio 491:161
Misoprostol gorup had Tx D1 and D3 then EPROC Day 8
Treatment failure: surgical Tx for miso group or repeat ERPOC

Question 7

Results

Answer 7

Miso group: 71% by D3, 85% by day 8
Treatment failure 16% in miso group and 3% EPROC group
Surgical 97% successful
No difference with haemorrhage or endometritis requiring hospitalisation <1% in either group
In the miso group 78% would use it again and 83% would recommend it to others

No difference in emergency room visits,
Miso alone had more nasuea, vomiting and abdo pain
Miso complications less then 1 in 70
3% presented to emergency within 24 hours