Treatment of first-trimester pregnancy failure with vaginal misoprostol is effective, well-tolerated, and acceptable to most women, according to a randomized trial.

Over 650 women with early pregnancy failure due to anembryonic gestation, embryonic or fetal death, or incomplete or inevitable spontaneous abortion received either 800 μg of vaginal misoprostol or vacuum aspiration. Researchers administered a second dose of misoprostol on day 3 if expulsion was incomplete and performed vacuum aspiration on day 8 if expulsion was still incomplete.

Of almost 500 women receiving misoprostol, 71% had complete expulsion by day 3 and 84% by day 8. Treatment failed in 16% of the misoprostol group and in 3% of the surgical group. Treatment failure was defined as surgical treatment for the misoprostol group and repeat aspiration for the vacuum group within 30 days of initial treatment.

No significant difference existed between the two groups in incidence of hemorrhage or endometritis requiring hospitalization (1% or less in each group). Although significantly more women in the misoprostol group experienced nausea, vomiting, diarrhea, abdominal pain, and severe pain, acceptability of the method was high with an equal percentage of women in each group probably or absolutely recommending the agent to others.

Zhang J, Gilles JM, Barnhart K, et al. A comparison of medical management with misoprostol and surgical management for early pregnancy failure. N Engl J Med. 2005;353:761-769.