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ORIGINAL RESEARCH |
From the Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
Address reprint requests to: S. L. Wood, MD, MSc, Foothills Hospital, Department of Obstetrics and Gynecology, 1403 29th Street, NW, Calgary, AB T2N 2T9, Canada; E-mail: stephen.wood{at}calgaryhealthregion.ca.
OBJECTIVE: To estimate the efficacy of vaginal misoprostol for medical management of missed abortion.
METHODS: Fifty women with missed abortion were randomized to treatment with up to two 800-mg doses of misoprostol vaginally or a placebo. Participants were reviewed daily for 2 days, then again at 1 week. A blood sample for hemoglobin and serum ß-human chorionic gonadotropin (ßhCG) was obtained on day 1 and the hemoglobin level checked again on day 7. Complete abortion was defined as expulsion of the products of conception without dilation and curettage (D&C) and a negative follow-up urine ßhCG test after 4 weeks, or as no products of conception obtained at D&C in cases of suspected incomplete abortion.
RESULTS: The rate of complete abortion was 80% (20 of 25) in the misoprostol group and 16% (four of 25) in the placebo group, relative risk 0.20 (0.08, 0.50), P < .001. The rate of D&C was 28% (seven of 25) in the misoprostol group and 84% (21 of 25) in the placebo group, relative risk 0.33 (0.17, 0.64), P < .001. One participant in the misoprostol group had an emergency D&C for heavy bleeding. No participants required blood transfusion. The mean reduction in hemoglobin from day 1 to day 7 was 3.2 g/L in the misoprostol group versus 4.3 g/L in the placebo group, P = .72. Patient satisfaction with misoprostol treatment was high with 19 of 21 participants reporting they would try medical management again if they experienced another missed abortion.
CONCLUSION: Medical management of missed abortion is effective, reduces the need for D&C, and is associated with high levels of patient satisfaction.
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