Alternative to Surgery for Miscarriage

A drug called misoprostol offers an alternative to surgery after miscarriage, according to a study published in the August 25, 2005, issue of The New England Journal of Medicine.

Misoprostol has been used to reduce the risk of stomach ulcers that occur in people who take certain pain relievers for arthritis and is commonly used to induce labor in pregnant women, since it stimulates contractions of the uterus. Doctors have begun prescribing misoprostol in recent years as an alternative to surgery in the treatment of miscarriage. The current study is the first to evaluate the safety and effectiveness of the drug for this use.

Miscarriage occurs in 15% of pregnancies. The fetus may die in the womb or may no longer be present. In both cases, standard treatment is vacuum aspiration, in which the cervix is dilated and a suction device removes the uterine contents. Some women may prefer to wait for the uterus to expel the tissue, but this may take more than a month and there is a risk of infection.

In the current study, researchers enrolled 652 women who had experienced a miscarriage. Of these, 491 were assigned to receive misoprostol in four vaginal doses. The remaining women underwent vacuum aspiration. By the end of the third day, 71% of the women receiving misoprostol had complete uterine expulsion. After five more days, 84% had complete expulsion. The misoprostol treatment failed for 16% of the group, while only 3% of the vacuum aspiration group had treatment failure.

"Misoprostol is inexpensive and does not need to be refrigerated,” noted first author Dr. Jun Zhang, M.D., Ph.D., an investigator in the epidemiology branch of the U.S. National Institute of Child Health and Human Development of the National Institutes of Health (Bethesda, MD, USA; www.nichd.nih.gov), which conducted the study. Moreover, Dr. Zhang noted that the treatment can be performed as an outpatient procedure. "It could provide treatment for miscarriage in developing countries where safe surgical treatment may not be readily accessible.”