Randomised trial comparing expectant with medical management for first trimester miscarriages

Objective To compare the efficacy of antiprogesterone (mifepristone) in com bination with a synthetic prostaglandin E-1 analogue (misoprostol) for outp atient treatment of miscarriages. Participants One hundred and twenty-two women with first trimester miscarri ages. Methods The women were randomised to treatment with mifepristone 400 mg ora lly followed by a single oral dose of 400 mu g misoprostol 48 hours later ( n = 60) or expectant management (n = 62). Women were re-evaluated five days later. If retained intrauterine products of conception were found with an antero-posterior diameter above 15 mm on transvaginal ultrasound, surgical evacuation was performed. Results Eighty-two percent of the women randomised to pharmacological treat ment and 76% of those randomised to expectant management had an empty uteri ne cavity after five days. Convalescence time was 1.8 days longer for women randomised to pharmacological treatment. Pain, bleeding, complications, an d satisfaction with the treatment did not differ between the groups. Conclusions Most cases of spontaneous incomplete miscarriage will become a complete miscarriage without intervention. This study shows that outpatient treatment with a combination of antiprogesterone and a prostaglandin E-1 a nalogue did not increase the rate of complete miscarriage, compared with ex pectancy alone, by a clinical important degree.