Vaginal misoprostol as medical treatment for first trimester spontaneous miscarriage

BACKGROUND: Misoprostol is effective for cervical priming prior to suction evacuation in first trimester pregnancy termination. This is the first rand omized study to compare vaginal misoprostol versus expectant treatment in w omen presenting with spontaneous miscarriage. METHODS: Sixty women presenti ng with spontaneous miscarriage were recruited to the study at the Queen Ma ry Hospital between 1998 and 1999, They were randomized to group 1: misopro stol; and group 2: expectant management. Women in the misoprostol group rec eived vaginal misoprostol 400 mug on days 1, 3 and 5, The expectant group w as followed up according to the same schedule. Suction evacuation was perfo rmed if there was excessive bleeding or abdominal pain; or if a gestational sac was detected by transvaginal scan on day 15, RESULTS: Fifty-nine women completed the trial. Those who did not require suction evacuation up to th e time of return of normal menstruation were considered to be successful. T he incidence of side-effects was comparable between the two groups. Three w omen in the expectant group and one in the misoprostol group underwent emer gency suction evacuation because of excessive bleeding. The mean duration o f vaginal bleeding was similar for both groups (14.6 days in the misoprosto l group versus 15.0 days in the expectant group), The successful rate in th e misoprostol group was significantly higher than that of the expectant gro up (83.3 versus 48.3%, P < 0.05), CONCLUSION: We recommend repeated vaginal misoprostol 400 mug given on days 1, 3 and 5 as a treatment option for wom en with first trimester spontaneous miscarriage.