Comparison Med mx misoprostol and surgical Mx for early pregnancy failure

Question 1

Comparison Med mx misoprostol and surgical Mx for early pregnancy failure
- N, study

Answer 1

Zhang et al
2005
RCT
N 652

Assess efficacy, safety and acceptability of misoprostol vs surgical management

Inclusion:
1st trimester pregnancy failure, randomised to (in 3:1 ratio):
- Misoprostol 800mcg PV (if no result – 2nd dose on day 3, D+C on day 8) (n=491)
- Suction D&C (n=161)

Question 2

Exclusion criteria: Comparison Med mx misoprostol and surgical Mx for early pregnancy failure

Answer 2

Exclusion criteria

• Hb < 95
• Haemodynamic instability
• Hx clotting disorder
• Anticoagulants
• Previous surgical or medical Rx this preg

Question 3

Outcomes: Comparison Med mx misoprostol and surgical Mx for early pregnancy failure

Answer 3

Primary:

• Success rate [84% miso vs 97% D+C]
• Haemorrhage, infection [1%; no diff]
• Patient satisfaction [78% would use miso again; 83% would recommend to others], no difference in susceptibility

Secondary

• Hospital admissions [unscheduled visits with miso but not sig]
• SEs (N+V, abdo pain) - tolerable

Conclusion:
Misoprostol is safe, efficacious and acceptable approach with success rate ~ 84%

Question 4

Conclusion: Comparison Med mx misoprostol and surgical Mx for early pregnancy failure

Answer 4

Misoprostol group:

• More nausea, vomiting, pain
• More unscheduled visits to hospital

Increased efficacy of misoprostol in the incomplete or inevitable group. However, most of those with other types of MC passed products with second dose.