American Journal of Obstetrics & Gynecology
Volume 196, Issue 1 , Pages 31.e1-31.e7, January 2007

Bleeding patterns after misoprostol vs surgical treatment of early pregnancy failure: results from a randomized trial

  • Anne R. Davis, MD

      Affiliations

    • Columbia University, New York, NY
    • Corresponding Author InformationReprint requests: Anne R. Davis, MD, Columbia University, Department of Obstetrics & Gynecology, 622 West 168th St, PH 16 Room 80, New York, NY 10032
    • ,
  • Sarah K. Hendlish, MPH

      Affiliations

    • Columbia University, New York, NY
    • ,
  • Carolyn Westhoff, MD

      Affiliations

    • Columbia University, New York, NY
    • ,
  • Margaret M. Frederick, PhD, MD

      Affiliations

    • Clinical Trials and Surveys Corp, Baltimore, MD
    • ,
  • Jun Zhang, PhD, MD

      Affiliations

    • National Institute of Child Health and Human Development, National Institutes of Health, Division of Health and Human Services, Bethesda, MD
    • ,
  • Jerry M. Gilles, MD

      Affiliations

    • University of Miami, Miami, FL
    • ,
  • Kurt Barnhart, MD, MSCE

      Affiliations

    • Penn Fertility Care and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
    • ,
  • Mitchell D. Creinin, MD

      Affiliations

    • University of Pittsburgh and McGee Women’s Research Institute, Pittsburgh, PA.
    • ,
  • National Institute of Child Health and Human Development Management of Early Pregnancy Failure Trial

Received 1 February 2006; accepted 5 July 2006.

Objective

The purpose of this study was to describe bleeding patterns after misoprostol or curettage for early pregnancy failure (EPF).

Study design

This was a randomized trial that included women (n = 652) with EPF. Participants were assigned to vaginal misoprostol (800 μg) or curettage in a 3:1 ratio. Participants completed a bleeding diary. We measured hemoglobin levels at baseline and 2 weeks after the treatment.

Results

Decreases in hemoglobin levels were greater after misoprostol (−0.7 g/dL; SD, 1.2) than curettage (−0.2 g/dL; SD, 0.9; P < .001). Large changes in hemoglobin levels (at least 2 g/dL) or low nadir hemoglobin levels (< 10 g/dL) were more frequent after misoprostol (55/428 women; 12.8%) than after curettage (6/135 women; 4.4%; P = .02). More participants in the misoprostol group reported “any bleeding” or “heavy bleeding” every study day. Four women who were treated with misoprostol required blood transfusion.

Conclusion

Bleeding is heavier and more prolonged after medical treatment with misoprostol than with curettage for EPF; however, bleeding rarely requires intervention.

Key words: early pregnancy failure, miscarriage, misoprostol, curettage

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 Funded by contracts (N01-HD-1-3321, N01-HD-3322, N01-HD-3323, N01-HD-3324, and N01-HD-3325) with the National Institute of Child Health and Human Development, National Institutes of Health.Cite this article as: Davis AR, Hendlish SK, Westhoff C, et al. Bleeding patterns after misoprostol vs surgical treatment of early pregnancy failure: results from a randomized trial. Am J Obstet Gynecol 2007;196:31.e1-31.e7.

PII: S0002-9378(06)01154-9

doi:10.1016/j.ajog.2006.07.053

American Journal of Obstetrics & Gynecology
Volume 196, Issue 1 , Pages 31.e1-31.e7, January 2007

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