Spontaneous abortion: a randomized, controlled trial comparing surgical evacuation with conservative management using misoprostol.

OBJECTIVE

To compare the efficacy of surgical evacuation of the uterus with medical evacuation using misoprostol in cases of spontaneous abortion.

DESIGN

A prospective, randomized, controlled trial.

SETTING

A university teaching hospital.

PATIENT(S): Six hundred thirty-five women who aborted spontaneously and who consented to pretreatment randomization.

INTERVENTION(S): Routine surgical evacuation or medical evacuation of the uterus using misoprostol.

MAIN OUTCOME MEASURE(S): Immediate, short-term (2-3 weeks), and medium-term (6 months) medical complications.

RESULT(S): There was a significantly lower incidence of immediate and short-term complications in the group treated with misoprostol compared with the surgically treated group. There were also fewer major complications in the 6 months after treatment in the medically treated group. Approximately 50% of the medically treated group subsequently required surgical evacuation, and these subjects required significantly more analgesia.

CONCLUSION(S): Treatment with misoprostol can reduce the demand for surgical evacuation in cases of spontaneous abortion, and its use is associated with fewer medical complications.