Zhang Miscarriage

Question 1

What is the question covered by the Zhang 2005 miscarriage trial?
What type of study was it?

Answer 1

RCT (non-inferiority)

What is the efficacy, safety and acceptability of medical management with misoprostol compared with vaccum aspiration?

Question 2

What was the study population?

What was the exclusion criteria?

Answer 2

Multi-centre (USA)
652 women with early pregnancy failure <13 weeks
- anembryonic gestation (36%)
- fetal or embryo demis (58%)
- incomplete or inevitable abortion (6%)

Exclusion criteria:
Anaemia
Haemodynamic instability
Clotting or bleeding disorder
Allergy to NSAID or PGs
Previous treatment this pregnancy

Question 3

Describe the intervention

Answer 3

491 received 800mcg misoprostol PV, repeated after 48hrs if expulsion incomplete

161 had vacuum aspiration

Question 4

What was the result of the primary outcome?

Answer 4

Primary outcome:
Success of treatment, defined as complete uterine evacuation without the need for further vacuum aspiration within 30 days.

Success in misoprostol group 84%
Success in surgical group 97%

Question 5

Name 5 secondary outcome findings?

Answer 5

1. The rates of haemorrhage and infection were the same between both groups <1%
2. There was a larger drop in Hb in the misoprostol group (5% vs 1%)
3. More adverse effects were noted in the misoprostol group (nausea, vomiting, pain)
4. The acceptability did not differ between groups
5. Unscheduled hospital visits were higher in the misoprostol group but this was not statistically significant.

Question 6

What is the take home message of the Zhang et al miscarriage study?

Answer 6

Medical management of 1st trimester pregnancy failure is a safe and effective alternative to surgical vacuum aspiration.