Medical vs surgical mx of miscarriage

Question 1

Study design

Answer 1

Randomised trial

Question 2

Participants

Answer 2

652 women with either ‘missed’ or incomplete miscarriage in the first trimester

Question 3

Primary outcome

Answer 3

Completion of miscarriage

Question 4

Intervention

Answer 4

Randomised to either misoprostol or suction vacuum

Misoprostol (PV) - 800mcg PO on D1 and repeated D3 if products not expelled.

If by D7 no expulsion of POC - had D&C

Treatment failure of miso if needed a D&C within 30 days of miso

3:1 ration (3x medical mx)

Question 5

Results

Answer 5

Misoprostol group:

• 71% by D3, 84% successful treatment by D8
• 1% required hospitalisation for endometritis/haemorrhage (no significant differences between groups)
• Treatment failure 16% in miso- 3% surgical, 12% difference
• In the misoprostol group, 78 percent of the women stated that they would use misoprostol again if
  the need arose and 83 percent stated that they would recommend it to others.

Question 6

Limitations

Answer 6

• Rx failure based on GS present or ET 30mm, much higher therefore could represent RPOC